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LIBRARY OF CONGRESS. 
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UNITED STATES OF AMERICA. 



NOTES 



H&TEBU HEDIGA AND TBEBAPEDTICS 



TAKEN FROM LECTURES DELIVERED 



Prof. WILLIAM H. THOMSON, M.D , LL.D. 



MEDICAL DEPARTMENT UNIVERSITY OF THE CITY OF NEW YORK. 






EDITED BY 



W. M. IL, McEKROE, M.D., 

ASSISTANT TO THE CHAIR OF MATERIA MEDICA, UNIVERSITY OF THE 
CITY OF NEW YORK. 



FOURTH EDITION, COMPLETELY REVISED AND ENLARGED. 



NEW YORK : 

Press of STETTLNER, LAMBERT & CO., 

22, 24 & 26 Reade Street. 




^ 



V 



Copyright, 1889. 

w. m. h. McEnroe. 



PREFACE 



In preparing the fourth edition of these notes, the editor 
has been thoroughly mindful of the introduction of several 
valuable drugs since the publication of the last edition, and the 
prominence given in recent lectures by Prof. Thomson to some 
of these, and the desirability of having fuller notes on some of 
the older remedies, have rendered necessary the issue of the 
present edition. Advantage has been taken of the occasion to 
make what is practically a new work, for the present notes are 
based upon stenographic .reports of the lectures delivered dur- 
ing the winter session of 1888-89, the material in the older 
editions for obvious reasons having been drawn upon to a 
slight extent only. 

To render the work as complete as possible, several mono- 
graphs by Prof. Thomson, bearing directly upon the uses and 
administration of drugs, have been introduced. Other new fea- 
tures are the frequent use of cross-references and a summary 
at the end of each of the principal drugs. 

Owing to the nature of the work, the appearance of a few 
errors, typographical and otherwise, is almost unavoidable, but 
none of them, I trust, will be found misleading. 



IV PREFACE. 

To Mr. Edward Merrins I am indebted for the full and 
careful notes of Prof. Thomson's lectures, and for invaluable 
aid in the preparation of the material for the press. 

If these notes are found helpful by the student, the object 
of their publication will have been attained. 

W. M. H. McEnroe, M.D. 
55 East 11th Street, October, 1889. 



TABLE OF CONTENTS. 



PAGE 

Classification of Medicines, 1 

PART I.— DISINFECTANT REMEDIES. 

Introductory to Disinfectants, 11 

General Disinfectants, 19 

Special Disinfectants, 

Lime, ' 20 

Charcoal, 22 

Carbolic Acid and allied Compounds, 24 

Chlorine, . . 31 

Bromine, 32 

Sulphur, 34 

Iodine, 34 

Boracic Acid, 35 

Permanganate of Potash, 35 

Uses of Disinfectants in the treatment of Special Diseases, ... 36 

PART IL— MEDICINAL REMEDIES. 

Introductory to Medicinal Remedies, 45 

CLASS I.— ORGANIC OR DISEASE MEDICINES. 
1. Restoratives: 

Cod-liver Oil, 52 

Iron, 62 

Phosphorus, 73 

Quinine 76 

Vegetable Bitters, 87 

Mineral Acids, 90 

Alkalies, 95 

Mineral Waters, 97 



VI 



TABLE OF CONTEXTS. 



PAGE 

2. Alteratives : 

Mercury, ... 104 

Iodine and Compounds, Ill 

Bromides, 117 

Arsenic, 127 

Silver, 133 

Zinc, 135 

Copper, 136 

Bismuth, 136 

Colcliicum, 136 

CLASS II.— FUNCTIONAL OR SYMPTOM MEDICINES. 



Neurotics ; 




Introductory, 


. 141 


Narcotics, 




Opium, 


144 


Alcohol, 


. 168 


Ethers, 


176 


Belladonna, 


. 179 


Hyoscyamus, . 


183 


Stramonium, 


183 


Cannabis Indica, 


185 


Stimulant Neurotics, 




Digitalis, 


190 


Strophanthus, .... 


192 


Nitroglycerin, ...... 


194 


Caffeine, 


196 


Ammonia, .... 


198 


Ergot, 


200 


Stiychnine, .... 


203 


Camphor, .... 


204 


Asafcetida, .... 


. . . . .204 


Valeriana, - 


205 


Depressant Neurotics, 




Aconite 




Veratrum Yiride, .... 


212 


Tartar Emetic, 


212 


Hydrocyanic Acid, .... 


213 


Conium, 


214 


Gelsemium, 


... . 215 



TABLE OF CONTENTS. Vll 

PAGE 

Anaesthetics, 219 

Cocaine, 219 

Chloral 220 

Paraldehyd, 222 

Sulfonal, . 223 

Phenacetin, 223 

2. Eliminatives or Glandular Medicines: 

a. Cathartics, 

Calomel, ' . 232 

Castor Oil, 233 

Aloes, 235 

Rhubarb, 235 

Cascara Sagrada, ......... 237 

Colocynth, 238 

Scammony, 239 

Jalap, 239 

Podophyllum, 239 

Elaterium, 240 

Camboge, ". 240 

Senna, 241 

Compound Cathartic Pills, 241 

Croton Oil, 241 

Sulphate of Magnesium (Epsom Salts), 243 

Sulphate of Sodium (Glauber's Salts), 243 

Cream Tartar, 243 

Tartrate of Potassium and Sodium, 244 

Phosphate of Sodium, 244 

b. Emetics, 

Apomorphine, 245 

Ipecacuanha, 246 

Sulphate of Zinc, 248 

Sulphate of Copper, 248 

c. Diuretics, 

Digitalis, ' . . . .250 

Mercury, 250 

Squill, 251 

Turpentine, 251 

Buchu, 252 

Juniper, . . . 253 

Cream Tartar, 253 



Vlll TABLE OF CONTENTS. 

PAGE 

d. J)iap7ioretics, 

Dry Heat, . . . ■ 255 

Moist Heat, 255 

Dover's Powder, 256 

Ammonia, ........... 256 

Sweet Spirit of Nitre, . 256 

Jaborandi, 257 

e. Expectorants, 258 

3. Astringents . 

Plumbi acetatis, 265 

Liquor Ferri Subsulphatis, 268 

Liquor Ferri Pernitratis, . . ... . . . 268 

Nitrate of Silver, 268 

Sulphate of Copper, 269 

Alum, 269 

Tannin— Tannic Acid, . 269 

PART III.— NON-MEDICINAL MEDICINES. 

Cold, 278 

Dry Heat, , 285 

Moist Heat, . 287 



CLASSIFICATION OF MEDICINES. 



All Kemedies may be divided into three classes: Medicinal, 
Non-Medicinal, and Disinfectant. 

A Medicine is a remedy which cannot act until it enters the 
Circulation in a state of solution. 

The circulation includes not only the blood, but also the interstitial fluid 
outside the capillaries, and which is the real nutritive fluid of the tissues. 
That it is in nearly as rapid movement as the blood itself, is shown by the 
quick diffusion of hypodermatic injections. 

Non-medicinal Kemedies are those which act without entering 
the Circulation, as Counter-irritants, Blisters, Caustics, Elec- 
tricity, Heat, Cold, Baths, Change of Scene or of Air, Massage, 
etc. 

Disinfectants either destroy the agents which cause the de- 
composition of organic textures and fluids, or else neutralize 
the poisons generated by the growth or activity of those agents. 



MEDICINES. 

Medicines are divided into two classes: 1. Organic or Disease 
Medicines. 2. Functional or Symptom Medicines. 

The Organic Medicines are those which act upon and modify 
the tissues or fluids of the body, so that after their action the 
system is not in the same state that it was in before their ad- 
ministration. Examples : Cod-Liver Oil in nutritive disorders, 
Iron in Anaemia, Mercury in Syphilis, etc. 

The Functional Medicines produce no recognizable effect upon 
the various bodily organs, but affect their functions instead. 

The function of an organ is its work, as Respiration the function of the 
Lungs ; Circulation the function of the Heart and Blood Vessels ; Secretion 



NOTES ON MATERIA MEDICA. 



the function of the Glands, etc. Thus Ammonia may stimulate the heart's 
work and Aconite depress it, so as to accelerate or slow the circulation ac- 
cordingly, but neither of these agents affects the structure of the heart itself. 
Opium or Tobacco leaves no traces on the Nerve Tissues, though taken for 
years for their effects on Nerve Functions. 

The two Classes of Medicines present the following contrasts in their char- 
acters : 



ORGANIC OR DISEASE MEDICINES. 

They are given for Diseases 
or Morbid Conditions, not for 
Symptoms. 

Thus Potassium Iodide is given not 
to relieve the pain of a syphilitic 
node, but to remove the node itself. 
They relieve symptoms, therefore, 
only indirectly, by removing their 
cause. 

They show the properties 
which lead to their use as medi- 
cines only in disease. 

Iron or Cod-Liver Oil does not 
strengthen persons in health. Mer- 
cury is a great restorer, provided 
there be Syphilis, etc. 

By a Morbid Condition, in distinc- 
tion from a Disease, is meant a state 
like Ansemia or like Dropsy, which, 
though definite, yet is the result of 
quite different causes in different 



FUNCTIONAL OR SYMPTOM MEDI- 
CINES. 

They are given for Symp- 
toms, not for Diseases. 

_ Thus Opium is given in inflamma- 
tion, fractures, cancer, neuralgia, 
etc., only for what these have in 
common — the symptom pain. 



Symptom Medicines act in 
health as well as in disease. 



Emetics or Cathartics, or Neuro- 
tics, will act the same whether taken 
by the well or by the sick. Hence 
their actions are often studied by ex- 
periments on animals. 



Their action is never secured 
by one dose, but only by re- 
peated doses. They, therefore, 
require time for their opera- 
tion, because they are cumula- 
tive, and hence their effect is 
more permanent. 



Their whole action is se- 
cured by one dose, and no dif- 
ferent effect follows upon re- 
peated doses. Hence they are 
not cumulative, and their effect 
is transient. 

Thus half a dose of a Cathartic or 
of an Emetic fails to produce any 
characteristic effect. Repeated doses 
of a Neurotic, also, only repeat the 
symptoms of the first dose without 
adding any further effect on the dis- 
ease or on the symptom. Thus 
Stramonium may relieve the symp- 
tom of spasm in asthma for a life- 
time, but the last dose has no more 
helped to cure the asthma than the 
first one. 



CLASSIFICATION OF MEDICINES. 



They should not produce 
symptoms. The patient should 
not know that he is taking any- 
thing except by noticing an 
improvement in his disease. 
Whenever they produce symp- 
toms of their own, they are 
either given in excess or else 
they are not suited to the case. 

Thus iron disagrees when it pro- 
duces headache. Quinine should 
not be pushed beyond the symptoms 
of cinch onism. Mercury ceases to 
be remedial after salivation begins, 
and iodine after the symptoms of 
iodism develop, etc. 

Disease Medicines are most 
commonly employed in the 
treatment of Chronic Diseases. 

Thus Cod-Liver Oil, while valu- 
able in Chronic Pulmonary Diseases, 
is useless in Acute Pneumonia. Iron 
is not given for the debility of fever, 
etc. 

Chronic Diseases are due to faults 
of the constitution, either inherited 
or acquired, and hence only organic 
medicines can permanently benefit 
them. The term Chronic shows that 
they have no tendency to spontane- 
ous recovery. 

In some cases a Disease Medicine 
can be made to act as a Symptom 
^»Iedieine, by giving it in the symp- 
tom way, viz., in one large dose. 
Thus Mercury in a large dose of 
calomel becomes a cathartic, but if 
so it ceases at once to act against any 
syphilis present in the system, for it 
cannot be both a Disease Medicine 
and a Symptom Medicine at the same 
time. 



They do not act unless they 
do produce symptoms. The 
dose of all Symptom Medicines 
is the quantity which will pro- 
duce the symptoms character- 
istic of the medicine, and no- 
thing less. 



Thus, while the ordinary dose oi 
opium for an adult is one grain, it 
may require in peritonitis twenty 
grains before a symptom of opium is 
obtained; if so, the dose then is 
twenty grains. 

Symptom Medicines are most 
commonly employed in the 
management of Acute Diseases. 

Acute Diseases, as inflammations, 
fevers, etc., are of the nature of acci- 
dents and may occur in the young 
and healthy. If uncomplicated, 
Acute Diseases are self -limited and 
terminate, with rare exceptions, 
within six weeks. Symptom Medi- 
cines are called for in them to relieve 
suffering and to prevent complica- 
tions, but not to cure the disease, 
which rather must be watched while 
it runs its course. 



4 NOTES ON MATERIA MEDICA. 

CLASS I.— ORGANIC OR DISEASE MEDICINES. 

Division I. — Restoratives. 

Characters: I. They are medicines which, are natural to the 
system, either because they are themselves ingre- 
dients thereof, or else analogous to what is so. 

II. They act by making up a deficiency in the 
system, by being themselves the thing deficient, 
or else similar to it. They are, therefore, of the 
nature of foods, and hence are beneficial only 
when the system is starved of the ingredient to 
which they correspond. Examples: Iron in anae- 
mia, Cod-Liver Oil when blood fat is wanting, 
etc. 

Restoratives and Disinfectants are the only prophylac- 
tics. 



Division II. — Alteratives. 

Characters: I. They are Organic or Disease Medicines un- 
natural to the system. 

They are, therefore, more or less poisonous, and this fact 
is to be remembered, because, though all Symptom Medi- 
cines are also unnatural to the system, yet complete recov- 
ery from the most active of them, like Opium or Aconite, 
is a question of hours only, while recovery from the injury 
of organic poisons may be very slow. 

II. They act in an unknown way only against 
certain special diseases or morbid conditions. 
The range of their remedial applications is there- 
fore more limited than with restoratives. 



CLASSIFICATION OF MEDICINES. 

Potassium Iodide acts promptly against syphilitic periosti- 
tis, but not to the same degree in other forms of periostitis. 
Colchicum is the remedy for gouty arthritis, but not for 
rheumatic arthritis, etc. 

III. When they act as poisons they produce 
characteristic symptoms, such as salivation by 
mercury, or iodism, bromism, etc. When they 
do so, they cease to act as remedies, and the dose 
should be lessened to that which does not cause 
symptoms, or else they must be abandoned. As 
their poisonous effects are both different from 
their remedial effects and inconsistent with them, 
an important rule in their lengthened administra- 
tion is to conjoin restoratives with them to post- 
pone their poisonous effects as long as possible. 



CLASS II.— FUNCTIONAL OR SYMPTOM MEDICINES. 
Division I. — Neurotics. 

Characters: I. They are medicines which produce their 
symptoms by affecting some nerve functions. 
Neurotics never act upon the whole nervous sys- 
tem, and hence the use of such terms as "gen- 
eral nervous stimulants or sedatives " is incorrect. 
The most widely operative neurotics, such as 
opium, are yet quite selective, and affect the 
functions of only a few out of the many nerve 
centres. 

II. As they are purely functional remedies, neu" 
rotics cannot cure real nervous diseases like epi- 
lepsy, asthma, etc., as these diseases are generally 
the most constitutional of all diseases. 



b NOTES ON MATERIA MEDICA. 

The effect of neurotics is usually weakened by repetition, 
so that the doses have to be increased. Yet they promote 
the action of organic medicines when they relieve special 
symptoms of the disease. Thus opium and conium ma- 
terially increase the efficacy of potassium iodide in syphili- 
tic periostitis when there is much pain, and on the same 
principle chloral, by lessening reflex excitability, assists the 
bromides in epilepsy. 

Neurotics may be divided into: 

a. Those which are both Stimulants and Sedatives (commonly 
called Narcotics). These agents generally stimulate some nerve 
functions, while they simultaneously depress others. Thus 
opium stimulates some of the higher cerebral functions and also 
stimulates the heart, and at the same time blunts sensation and 
paralyzes the alimentary canal. 

Or else these agents first stimulate certain functions and after- 
wards depress the same, but secondarily from exhaustion. 

ft. Those which are Stimulants only of certain nerve func- 
tions. Examples: Ammonia on the heart, Valerian and Asafce- 
tida on the abdominal ganglia, etc. 

c. Those which are Sedatives only of certain nerve functions, 
as Hydrocyanic Acid of the respiratory function. , 



Division II. — Eliminatives or Glandular Medicines. 

Characters: I. These medicines increase gland secretion. 
They are given more against complications occur- 
ring in the course of acute or of chronic diseases 
than against mere symptoms. 

Thus fever arrests secretion, and therefore, if long con- 
tinued, endangers life by the complication of starvation 
from deficiency of digestive secretions in the alimentary 
canal, and by the complication of self -poisoning from re- 
tained excretions. Eliminatives here are useful, not to 
eliminate the disease, but to modify these complications. 



CLASSIFICATION OF MEDICINES. 7 

II. By them also the different gland secretions 
are sometimes made to act vicariously for some 
one deficient gland function, as when Cathartics 
and Diaphoretics are used in kidney disease. 

These medicines are divided into: 

a. Cathartics, which increase the secretion of the intestines. 

h. Emetics, which act upon the secretions of the pharynx, 
stomach, liver, and duodenum in the act of emesis. 

c. Diuretics, which act on the kidneys. 

d. Diaphoretics, which act on the skm. 

e. Expectorants, which act on the bronchial secretion. 



Division III. — Astringents. 

Characters: These medicines constringe muscular and fibrous 
tissues and diminish secretion. They are also em- 
ployed for arresting haemorrhage by coagulating 
the blood. 

They are divisible into: 

a. Mineral Astringents. 

I. Vegetable Astringents. 



PART I. 



DISINFECTANT REMEDIES. 



DISINFECTANT REMEDIES. 



GENERAL INTRODUCTORY. 

Disinfectants are remedies which are used for the prevention 
of those diseases which come to us from without, and are not 
directly due to anything which is in the system itself. These 
diseases are accidents, and have nothing of the nature of consti- 
tutional diseases. 

The causes of these diseases are external, and the patient is 
not directly responsible for an attack unless he wilfully places 
himself in those surroundings where he knows the disease exists. 
Thus, two persons may he attacked by small-pox, one haying 
unwittingly come in contact with a person suffering from the 
disease; to this man the disease is an accident. The other per- 
son wilfully, and with full knowledge of the fact, incurred the 
risk of infection ; this cannot be called an accident. Never- 
theless, to both persons the cause of the disease came from with- 
out their own bodies. It was an external cause. 

It is now almost the unanimous opinion of the medical pro- 
fession that these extraneous, accidental diseases — of which 
smallpox may be taken as a type — are caused by living organ- 
isms, not by any physical or chemical agency. Disinfection 
means simply the endeavor to destroy these organisms, either 
directly by the disinfectant employed, or indirectly by the pro- 
duction of an agent inimical to their vitality; and hence any 
disease against which disinfectants can be successfully employed 
must be produced by these organisms. To speak, therefore, of 
eliminating the " poison " in these diseases shows an erroneous 
conception of the nature of their cause, for, irrespective of the 
dentification of the organisms by the microscope, the various 



12 NOTES ON MATERIA MEDICA. 

processes occurring in the course of these accidental or "com- 
municable " diseases differ in all their essential features from 
those produced by poisons. The word "poison " in its strict 
sense means a definite chemical substance, devoid of life, that 
produces disease or death after having entered the circulation; 
but the meaning of the term has been extended to embrace also 
those substances — e.g., caustics — which cause death or serious 
bodily harm by their chemical action upon the tissues with which 
they come in contact. That these diseases are due to living or- 
ganisms and not to poisons is conclusively shown by the follow- 
ing facts: (1) In poisons, quantity is an essential element: a cer- 
tain amount will prove fatal, a lesser amount will not be fatal, and 
a minute amount may act medicinally. On the other hand, in 
these diseases quantity is unimportant, the small amount of 
virus introduced into a person's system by inoculation infecting 
him to as great an extent as though a much larger quantity had 
been used. (2) In the case of poisons, time is an unimportant 
element, for, though there may be delay in absorption, as soon 
as a poison enters the circulation its characteristic effects are 
immediately produced; but where diseases are dependent upon 
living organisms, there must be a certain period before the symp- 
toms of disease are manifested. This latent period, called "incu- 
bation " (an unfortunate term, as it implies animal origin, and 
should be replaced by that of "germination"), is followed by the 
period of development, which is characterized by certain changes 
which are never reversed. (3) Following this period of de- 
velopment we have the most positive proof of the character of 
these morbid agents in the great feature of reproduction, as 
there is nothing in chemistry or physics that can reproduce 
itself. Thus, for example, the organisms in the minute quan- 
tity of variola -lymph introduced into the system by inocula- 
tion reproduce themselves to such an extent as to enable us 
to obtain from the person so infected a quantity sufficient to in- 
fect multitudes. This element of reproduction is the cause, and 
the only cause, of these diseases being dangerous. Immunity 
from the effects of any one of them depends on the virus being 
unable to reproduce itself in the system of the person exposed to 
its influence, and, conversely, the severity of the disease will be 



DISINFECTANTS. 13 

in proportion to the receptivity of the soil on which these or- 
ganisms — or, as they might be termed, seeds — will fall. Thus, 
of five persons exposed to the influence of one of these communica- 
ble diseases, two may be violently affected by it and die, two may 
be totally unaffected by it, and one may be affected slightly. 
"With poisons, however, the results are invariable; a dose of 
strychnine, for instance, producing precisely the same effects in 
one person as in another. (4) The variations in type and sever- 
ity of these diseases from year to year also show that they are de- 
pendent upon living organisms; for these variations never hap- 
pen with poisons, but growths are constantly having fluctua- 
tions in their reproduction. (5) The transportation of poisons 
from one country to another does not affect their peculiar prop- 
erties, but growths are very much affected by soil, climate, alti- 
tude, etc., and so we find that many of these diseases are 
endemic; for instance, cholera cannot ascend a mountain, and 
yellow fever is checked by frost. 

It is thus shown that we have to deal with agents that live 
and grow, and which never originate spontaneously; and the 
microscope, which confirms these deductions, reveals to us the 
fact that we are living in an immense ocean of minute forms of 
organic life, compared with which the world of life we see 
around us with the naked eye is quite small. Eeasoning from 
analogy, and from the fact that no form of li'fe can live for it- 
self, we should expect that this kingdom of microscopic life, by 
far the largest and most universal, must have very important re- 
lations to other departments of life, and this we find to be the 
case. Without the aid of these minute organisms there would 
be no vegetable growth, as the fermentation they produce is es- 
sential to the fertility of the soil; for it has been found that soil 
which has been sterilized will not support vegetable life. To a 
very large extent they furnish the microscopic nuclei to the at- 
mosphere which serve for the precipitation of watery particles, 
and thus they assist in the formation of clouds; for in air which 
has been filtered through cotton, and thus rid of all solid matter, 
the introduction of steam is not followed by a ' ' cloud " or 
"mist," but it immediately condenses as water. If, therefore, 
we were living in a perfectly pure atmosphere, there would be 



14 NOTES ON MATEEIA MEDICA. 

no clouds and consequently no ram; the whole earth would be a 
desert, for as fast as water was evaporated from the ocean it 
would return, unable to find a resting place for its particles. 
What is still more important, however, is the fact that if it were 
not for these organisms nature would very soon be choked with 
her own dead. Decomposition of either animal or vegetable 
substances never occurs spontaneously, but is brought about by 
the agency of these organisms in a complex series of processes. 
In the putrefaction of ordinary butcher's meat, no less than 
eight kinds of organic life, differing in form, activity, and chemi- 
cal results, succeed each other, in an order which is rarely re- 
versed, before decomposition is complete, the processes being 
analogous to those in the decomposition of vegetable matter — 
e.g., alcoholic fermentation, where the alcoholic plant is succeeded 
by the acetic acid plant. These facts have an important and 
significant bearing on the subject of the growth of the organisms 
by which communicable diseases are produced, and they direct 
attention to a stage (the post-latent) of these diseases to which 
heretofore there has not been attached sufficient importance, but 
to which these facts give a very decided clue as to its actual ex- 
istence. 

Communicable diseases are characterized by a " latent stage," 
or, as it might now more correctly be termed, a "pre-latent 
stage " — the period of incubation or germination. This is fol- 
lowed by the period of development, after which comes the pe- 
riod of reproduction, to be succeeded by the apparent recovery 
of the patient. But the disease has not yet been conquered; the 
recovery is only apparent, for there now succeeds another latent 
stage, which may be termed the " post-latent." For instance, 
at the end of a certain time the kidneys may be affected after an 
attack of scarlet fever, and paralytic troubles may follow diph- 
theria; measles may end in chronic asthma, and measles and 
scarlet fever may both be succeeded by nasal catarrh and otor- 
rhea. These manifestations of the post-latent stage are not the 
sequelae of the original complaint, but are indications of a new 
disease due to the development of other bacterial growths, because 
every one of these diseases due to an organism of its own pre- 
pares the way for another disease which but for it would not 



DISINFECTANTS. 15 

appear. We are thus living in a world of life which is ever 
ready to seize upon and destroy anything that shows a weakened 
vitality — a vitality insufficient to repel or overcome them. 

This subject should be thoroughly studied, not so much to 
discover this or that disease, as to enable us to grasp the general 
laws of this microscopic world, and to infer from them facts 
which would be obscure if we studied the specific forms "by 
themselves. For instance, in phthisis, a bacterial disease — the 
microscope here affording us a means of diagnosis superior to 
that of physical exploration, as we can by its use determine 
with certainty the presence of the disease where otherwise we 
would be in doubt — there is the suggestive fact that it does not 
prevail anywhere in the world where the soil is permeable to 
water to the depth of about thirty feet; but in proportion as we 
come to soil which holds water two or three feet below the sur- 
face of the earth, there phthisis most extensively prevails. This 
disease, therefore, is due to the introduction into the system of 
germs which are dependent upon a certain condition of the soil, 
not to atmospheric bacteria; hence to get rid of the disease the 
soil must be dealt with. 

In regard to the probable action of these germs ' in producing 
disease, there is no doubt but that the blood, in a large pro- 
portion of cases, is the medium of infection; for instance, in 
anthrax the bacilli seem to originate and multiply in the red 
blood-corpuscles, rendering them unfit to carry on their func- 
tions and thus causing death. More commonly, however, 

1 Bacteria are simple, microscopic, vegetable cells, usually very minute, 
composed of protoplasm with perhaps an enveloping membrane. They 
multiply often with great rapidity by transverse division or by the formation 
of spores, the latter being vastly more resistant to destructive influences than 
the bacteria themselves. According to shape, they are divided into (1) 
micrococci, round or sphsero bacteria : (2) bacilli, or desmo-bacteria, rod- 
shaped bacteria ; (3) spirilla?, or spirochcstc? , spiral-shaped bacteria. The mi- 
crococci of pus occur singly or in irregular clusters called staphylococci, or 
in chains called streptococci. The forms most frequently found in the pus of 
acute abscesses are the staphylococcus pyogenes aureus and the streptococcos 
pyogenes albus. There are a great many other varieties of micrococci, but 
these are the principal. 



16 NOTES OK MATERIA MEDICA. 

their action is by the generation of a poison, 1 as in septicae- 
mia. 2 Since the identification of the bacillus of Asiatic cholera, 
attention has been directed to the alimentary canal as the seat of 
generation of morbid bacteria. This disease and those of com- 
mon cholera, yellow fever, dysentery, cholera infantum, etc., 
are now supposed to be due to the development of bacteria in 
,the intestines. 

The extraneous or accidental diseases due to the presence in 
the system of some form of organic life may be divided into two 
classes, each with its special distinctive marks : (1) the " com- 
municable"; (2) the "non-communicable/' 

I. Communicable Diseases. — In this class it is necessary that 
the disease shall have previously existed as such in an animal 
body, and its reproduction in the newly infected person be merely 
a succession of kind. Usually, infected animals communicate 
the disease to members of the same species, as man to man, but 
sometimes the disease is conveyed from man to animals and vice 
versa. The term "communicable " is used advisedly to desig- 
nate this class of diseases, in preference to the word "conta- 
gious/' for the derivation of the latter term conveys the errone- 
ous impression that contact is necessary to the spread of the 
disease. In former days, this impression was the cause of 
very dangerous confusion; for if a disease actually spread 
from one person to another, and yet did not affect those who 
touched the patient, it was not considered to be contagious, but 

1 The word is here used in its stricter meaning. For definition, see ante, 
p. 12. 

2 Septicaemia is a condition of the body produced by the presence of an ex- 
tremely virulent poison, the product of the growth of certain forms of bac- 
teria, which has a tendency to precipitate the fibrin-producing elements of 
the blood and to cause the formation of minute emboli. The poison is a 
definite chemical substance, devoid of life, and consequently producing 
effects corresponding to the amount absorbed. Septicaemia may be pro- 
duced by pyaemia. 

Pycemia is a condition of the body caused by the presence of morbific 
bacteria, which are capable of multiplying themselves to such an unlimited 
extent as to cause death, either physically by interference with the vital 
functions, or chemically by the production of a virulent poison. Pyaemia 
is never the result of septicaemia, but may cause it. 



DISINFECTANTS. 17 

due to something in the air, and hence no precautions were 
taken. On this account, Asiatic cholera, a very communicable 
but not a contagious disease, carried off thousands upon thou- 
sands; but when this disease last appeared in New York, all 
houses were thoroughly disinfected, and the disease was stamped 
out with the same directness that firemen stop a conflagration. 
The virus of this disease (as well as of some others of this class), 
when it leaves one body, is not immediately ready to enter an- 
other, but seems to pass through an intermediate stage upon the 
surface of the ground or in the air; but it is just as communi- 
cable as that of small-pox, and no case of cholera occurs with- 
out the infection coming from one who has the disease. The 
word <e contagion " proposed to define the mode of communica- 
tion; the term " communicable" does not. 

The communicable diseases are subdivided into two classes: 

1. Specific. — In this class each disease has its own marked or 
distinctive symptoms, which are invariably produced in new cases. 
These cases are the reproduction of the original disease, which 
is never changed into any other form by pre-existing or inter- 
current diseases. Examples: measles, small-pox, scarlet fever, 
etc. 

2. Septic. — The diseases in this subdivision have certain class 
characters, but it is impossible to predicate the form they will 
take in every new case. Thus the introduction of erysipelas 
into a surgical ward is apt to develop pyaemia, while, if intro- 
duced into an obstetrical or gynaecological ward, puerperal fever, 
peritonitis, septicaemia, etc., are induced. The cause of these 
diseases is one and the same, but its manifestations vary accord- 
ing to the soil on which it falls. 

II. Non-communicable Diseases. — These diseases are caused 
by morbific agents which do not come from an animal body, but 
have their origin in a place or thing. Many of them are con- 
veyed through the air or water, and these diseases are usually 
termed malarial; but as the germs are carried as often, if not 
more often, by water than by air, the term (meaning " bad air") 
is an unfortunate one; and li miasmatic/' also used to designate 
them, is equally unfortunate. The germs may also have been 
2 



18 



NOTES OX MATERIA MEDICA. 



conveyed from the soil or from articles of clothing. Thus in 
yellow fever the infection is far more likely to be carried by 
wearing apparel, holds of ships, etc., than by the air. This is 
proved by the fact that the physicians and nurses, who attend 
cases of yellow fever after they have been sent to the hospital 
and divested of their clothing, never catch the disease, while the 
quarantine physicians, and those brought in contact with the 
clothing and surroundings of the patients on their arrival, are 
almost invariably stricken with the disease. 

Therefore, if patients suffering from these diseases are with- 
drawn from the infected localities, they may freely be admitted 
among those in health, as they no more communicate the disease 
to others than a person could communicate the injurious effects 
of a dose of arsenic . Another peculiarity about this class is that 
the infection may be confined to a very circumscribed space. 
Hence, for instance, if one small room should be omitted in the 
general disinfection of a ship in which there have been cases of 
yellow fever, persons entering that room are liable to the infec- 
tion. 

CLASSIFICATION OF "ACCIDENTAL" DISEASES. 



'1. Communicable. 
Origin in animal 
body. 



Accidentall 
diseases. 



f (a) Specific. — Measles. 

Scarlet Fever. 
Small-pox. 
Typhus Fever. 
Typhoid Fever. 
Asiatic Cholera, etc. 

(b) Septic— Erysipelas, and diseases to 
which it gives rise, etc. 



2. Non-communi- 
cable [syn in- 
fectious, mala- 
rial, miasma- 
tic]. 

Origin in place or 
thing not in 
animal body. 



Yellow Fever. 
Malarial Fevers. 



DISINFECTANTS. 



19 



CLASSIFICATION" OF PRINCIPAL DISINFECTANTS. 





Special Disinfectants. 


General Disinfectants. 


Carbolic Acid Class. | Chlorine Class. 


Unclassified. 


Free ventilation 


Carbolic acid 


Chlorine and 


Lime 


Absence of air 


Creosote 


compounds 
Bromine and 


Charcoal 


Extreme heat 


Salicin and 


compounds 


Corrosive subli- 




compounds 




mate. 


Extreme cold 




Iodine and com- 




Water 


Naphthaline 
and com- 
pounds 


pounds 


Boracic acid 
Permanganate 


Perfect dryness 




of Potash 




Chinoline and 
compounds 




Sulphur and 
compounds 




Benzoin and 








compounds 








Camphor 








Thymol and 








compounds 








Oil of pepper- 








mint 








Oil of winter- 








green 







GENERAL DISIKFECTAKTS. 

All forms of life, especially those with no protective covering, 
live in a medium of very narrow range, and hence, as the action 
of disinfectants is explicable only upon the supposition that 
they destroy life, total opposites, as extreme heat and extreme cold, 
are equally effective. Thus, if the infected clothes of a yellow- 
fever patient are heated in a temperature of from 300° F.-400 F., 
the germs will be destroyed ; but frost will destroy them equally 
well. Water is a good disinfectant (and before a surgical 
operation the body should be thoroughly washed), but perfect 



20 NOTES ON MATEKIA MEDICA. 

dryness is better yet ; for in the deserts of Arabia, where dead 
bodies are frequently left exposed to the air, they are never 
found in a putrefactive condition, but in a state of desiccation. 
The germs will cease to exist in the absence of all air, hence 
canned goods,but a free supply of oxygen will answer the same pur- 
pose just as well; for if plenty of fresh air be admitted into a room 
on the walls of which various fungi are growing, they will dis- 
appear. This has an important practical bearing on the treatment 
of those common and dangerous diseases connected with the bac- 
teria of pus, which are particularly unable to stand much oxygen, 
and brings up the subject of climatology. For instance, in tuber- 
cular inflammation of the lungs, where the severity of the disease 
is due to their necessarily unresting condition, it depends upon 
the locality whether pus, with the consequent ulcerative pro- 
cesses, will be present or not. The tubercle bacilli, were it not 
for their dangerous alliance with pus bacteria, would be relatively 
inert, and against the latter pure air is the best disinfectant. 
Hence phthisical patients should be advised to always have 
their bedroom windows well open (taking care to have the pa- 
tients warmly covered), to live as much as possible in the open 
air, and, if a change of climate is to be made, to go where they 
can remain in the open air the longest, as an outdoor life will 
better enable them to contend with their disease. These are 
the general disinfectants, which should be used as much as pos- 
sible with the special disinfectants now to be dealt with, main 
reliance being placed upon fresh air, particularly in cases of 
diarrhoea, dysentery, and children's diseases. 



SPECIAL DISINFECTANTS. 

Lime. — The power of lime as a disinfectant depends upon the 
following chemical and physical properties : (1) As a caustic 
alkali it destroys all forms of microscopic life brought in contact 
with it. (2) As quicklime it has the property of absorbing mois- 
ture to an extraordinary degree, and has a greater affinity for 
water in the tissues of growing forms of life than for water in 
its natural state, as in the former case the water is in a state of 
molecular division that subjects it more readily to chemical 



DISINFECTANTS. 21 

action. (3) During the process of hydration, intense heat is 
generated, which sets up currents in the surrounding atmo- 
sphere, and whatever germs are floating in the air are brought in 
contact with the lime and thus destroyed. (4) After hydration, 
lime is an antacid, preventing and destroying fermentation. 

Uses as a Disinfectant. — Lime is the best of all disinfectants 
for those diseases due to germs having their habitat in the soil. 
It has already been stated that these soil bacteria are essential 
to vegetable growth, but many of them are capable of generat- 
ing disease. This is proved by the fact that whenever the soil 
is upturned in this city (New York) for any distance, there is 
always an outbreak — usually within twenty-four to forty-eight 
hours thereafter — of various forms of disease, such as neuralgia, 
headache, sore throat, boils in the nose, and very serious mala- 
rial trouble, along the line of the excavations. Furthermore, 
nearly every house has a place perfectly adapted for the genera- 
tion of these morbific agencies of the soil — viz., its cellar. Many 
of the diseases generally ascribed to sewer gas are really due to 
underground cellar air circulating through the house, especially 
during the night. One proof of this is that persons at work in 
sewers, while they may have symptoms of poisoning due to the 
inhalation of sulphuretted hydrogen, rarely have the sore throat 
with follicular tonsillitis, the headache, derangement of kidneys, 1 
malaise, etc., characteristic of diseases due to germs emanating 
from the soil. We also find the additional fact that in a cellar 
population there is total absence of a healthy color in the faces 
of the children, and they are greatly troubled with tendency to 
diarrhoea, obstinate night cough, sore throat of a special kind, 
capricious appetites, and occasionally malarial disease. (Qui- 
nine should be administered in these cases.) Moreover, whenever 
the thermometer falls to about 10° above zero, there will be a 
general outbreak of malarial complaints, due to the warm air of 

1 One of the results of this derangement of the kidneys is the presence 
of blood, and consequently albumin, in the urine. Not unfrequently med- 
ical students who discover albumin in their urine imagine themselves 
to be in the incipient stages of Bright's disease, whereas the trouble is 
due to this malarial infection, contracted from occupying rooms on the 
top floors of houses in which cellar air ascends. Quinine should be taken. 



22 • NOTES OX MATERIA MEDICA. 

the cellar ascending through the house, using the various parti- 
tions, crevices, holes in connection with gas pipes, etc., as con- 
duits, until finally it reaches the top floor, where it remains. 
Hence the occupants of rooms on this floor are more likely to be 
affected than those on the floors immediately beneath. The 
cellar always has a musty smell, as if something were coming out 
of the ground, no matter how well ventilated it may be. How 
is this cellar air to be kept from infecting the house ? Lime is 
the only trustworthy agent for this purpose. Two pounds of 
lime will last for eight or ten days, except when the ground is 
surcharged with moisture, when it will have to be renewed 
more often. 

Lime, both in the form of quicklime and as whitewash — 
hydrated lime, which, although no longer capable of absorbing 
vapor, retains its alkaline property and is a valuable adjunct to 
quicklime — should also be used in hospitals for ground disin- 
fection and whenever there is an epidemic of diphtheria and of 
specific diseases of malarial type. It is also one of the best dis- 
infectants against typhus fever, the disease that physicians 
should most dread, as more die from it than from any other one 
disease, and which is the most terrible of all where people, as in 
the hold of a ship, are crowded together. Wherever typhus 
fever prevails whitewash should be freely used. Unfortunately 
it is of little use against typhoid fever. To disinfect a ward of 
hospital gangrene and erysipelas, it should be thoroughly white- 
washed every five days, as at the end of that time the white- 
wash has lost its most effective properties. Where rooms, owing 
to excessive dampness and imperfect ventilation, have various 
forms of fungi growing on the walls, fresh quicklime, in the pro- 
portion of one pound to a room twenty-eight feet square, will 
quickly destroy these germs. 

As lime-water it is given internally to correct acid fermenta- 
tion in the stomach and intestines, shown by sour vomit or 
ejecta. 

Charcoal. — This is a purely physical agent, and operates as a 
disinfectant by its power of absorbing into its pores, and packing 
them away into a very small compass, many gaseous bodies and 
vapors — e.g., it will absorb ninety times its own volume of am- 



DISINFECTANTS. 23 

monia. This property, though not an exception in the physical 
world (as it is possessed by all elementary substances in solid 
form), cannot be explained by any known physical laws, as no 
pressure is exerted. The dissolution of several substances in 
water without the latter increasing in bulk may afford some 
analogy, but does not solve the question, as this also is a mys- 
tery. That charcoal simply packs the gases away is shown by 
the fact that when subjected to a certain heat they are released, 
and the characteristic smell of the gases which the charcoal had 
deodorized returns with their expulsion. If it be a morbific gas 
which has thus been absorbed and expelled, does its power to 
produce disease return with the smell ? A question such as this 
is based on the erroneous theory, which has not yet disappeared, 
that bad smells are in themselves the cause of disease, and that 
if a thing be deodorized it is necessarily disinfected. Nothing 
in the form of a gas is per se injurious unless it is so purely by 
reason of its chemical or physical properties. All morbific 
agents are solid bodies, and do not become a part of the medium 
in which they exist; for air may be freed from them by passing 
it through cotton wool, and those contained in water are unable 
to pass through a porcelain filter. When a thing smells bad, 
therefore, it is no proof that it is injurious; and, on the other 
hand, when we get rid of the smell it is by no means certain 
that we have done away with a cause of disease. Consequently, 
the value of an antiseptic or deodorizer is to be judged, not by 
its power of causing bad smells to disappear, but by its fatal 
effect upon low forms of life. 

The uses of charcoal as a disinfectant are: 

1. As a Purifier of Drinking-Water. — During the process of 
liberation from charcoal, gases are in their nascent state, and 
therefore much more active chemically. Oxygen (which is 
very readily given up by charcoal), when in this condition, is 
extremely fatal to all low forms of life, attacking cryptogamous 
plants and the coloring matter of vegetable tissues with great 
energy. Hence it is an admirable purifier of drinking-water by 
destroying those microscopic forms of vegetable life which are 
almost universally in the waters of this country, and, being itself 
insoluble, does not communicate any of its own properties to 



24 NOTES ON MATERIA MEDICA. 

the water. Therefore in malarious districts where dysentery, 
diarrhoea, etc., prevail, drinking-water should either be boiled 
or passed through a charcoal filter. 

2. As a Deodorizer. — Charcoal is an almost perfect deodorizer, 
and therefore may be used to absorb the odor from ill -smelling 
surfaces of wounds, ulcers, gangrene, etc. , by mixing it with the 
poultices. 

3. As an Internal Remedy. — Where there is fermentation and 
putrefaction in the alimentary canal from the bile being with- 
drawn or perverted, with a consequent tendency to dysentery, 
dyspepsia, eructation of malodorous gases, foetid discharges, etc., 
well-prepared charcoal (gr. x.-xx., t. i. d.) is both a corrective 
and curative, and does not counteract other antiseptics. 

4. As a Sanitary Agent. — As charcoal operates differently to 
quicklime, large quantities of these substances may be used to- 
gether in the disinfection -of a house where there is bad drain- 
age, the one rendering the other more operative, both acting 
independently. 

Simply heating the charcoal will renew its powers of absorp- 
tion where these have been lost from its constant use. 

Carbolic Acid and allied compounds. — Carbolic acid is a 
chemical rearrangement of the particles of matter which make 
up vegetable tissue. It is obtained from coal tar by distillation 
and subsequent purification, many of its allied compounds being 
also products of this substance. Its action as a disinfectant 
depends more upon its destructive effects upon the vitality of 
matter than upon its chemical or physical properties. 

Properties — In tropical countries where, from the extreme 
fertility of the soil and consequent luxuriant vegetation, there is 
a struggle for existence among the various forms of plant life, 
Nature, ever careful to protect the reproductive function, has 
given to every seed its own peculiar secretion (which afterwards 
appears in the plant) to keep it from putrefaction and as a pro- 
tection from attack either by fungi or insects. Herein lies the 
explanation of the antiseptic properties of substances derived 
from coal tar (obtained from coal, which is simply woody fibre 
that has been subjected to enormous pressure for ages), and those 
of the prodigious number of secretions of the nature of camphor, 



DISINFECTANTS. 25 

cinnamon, nutmeg, cloves, pepper, ginger, etc., closely allied to 
carbolic acid. The disinfecting and preserving power of this 
class is seen in the action of spices in preserving fruit; smoke 
(another member) has been used from time immemorial for the 
preservation of fish and meat, Wood soaked in coal tar resists 
decay. If a solution of carbolic acid, twenty grains to the pint, 
is injected into the veins of a corpse, it will p reserve it for a 
long time. Oil of mustard, or simple powdered mustard, will 
remove the odor from the hands after working in the dissecting- 
room. Administered in large doses, carbolic acid, which may 
be taken as a type of the others, produces: (1) a weakening of 
the muscular contractions of the heart, which then beats faster 
to make up for deficiency of power, and ultimately symptoms of 
cardiac paralysis with distressing palpitation and feeble pulse; 
(Z) a paralysis of all nervous phenomena, sensation being the 
most important, and hence it is an anaesthetic; (3) symptoms 
connected with the special senses indicative of weakness, one of 
the most common being tinnitus aurium, or ringing in the ears, 
followed by a neuralgic pain in the temples; (4) weakness of 
respiration, which sometimes suddenly stops, life usually ending 
in convulsions, generally of tetanic nature. 

Carbolic acid and the other members of this class possess poi- 
sonous properties which enable them to restrain and finally 
abolish the vital properties of protoplasm, and they are therefore 
called paralyzers and antiseptics, in the sense that they will pre- 
vent decomposition due to the presence of bacteria by destroy- 
ing them. Not a single form of living protoplasm can be brought 
in contact with carbolic acid without being destroyed ; but, owing 
to the difficulty of absorption and the great protection afforded 
by basement membranes, the destructive effect of carbolic acid is 
not so great among the higher forms of life as in the microscopic 
world, where the lower we go the thinner becomes the external 
covering until we reach the fungi and algEe, which are immedi- 
ately destroyed by it; and upon this property depends its value 
as an antiseptic. It is therefore not a universal disinfectant, 
and should be used, not against the specific or communicable 
diseases, but against septic diseases— those due to the decomposi- 
tion of pus, where it is the disinfectant ' ' par excellence/' 1 A 

1 For the uses of carbolic acid in the treatment of wounds, etc., see p.' 41. 



26 NOTES ON MATERIA MEDICA. 

great many of these antiseptic remedies pass into the system 
in a state of solution, and go to every part of the body by the 
interstitial circulation. The first and best illustration of these 
is : 

Salicin. — As its name implies, salicin is a neutral principle, 
termed in chemistry a glucoside, obtained from the bark of dif- 
ferent species of willow— order salicacece. It is found in long, 
fine silky crystals, of bitter taste and insoluble in water. From 
this principle are derived salicylic acid and the various sali- 
cylates. In large doses salicin will produce the same topical 
effects as a similar dose of carbolic acid, but not with equal 
severity; for the former has never caused death, the cases which 
have been so reported being due to the impurities combined with 
it, not to the salicylic acid itself. Along with these special 
actions, certain rheumatic affections, notably acute articular 
rheumatism, are very decidedly relieved from pain by salicylic 
acid. Acute articular rheumatism, which differs essentially in 
its origin and nature from chronic rheumatism, is a disease of 
early life, occurring most commonly between the ages of twenty 
and thirty, it being a very rare occurrence for a first attack to 
happen after forty years of age. Previous to fifteen years of age 
the disease assumes an entirely different form, appearing as 
chorea, or St. Vitus' Dance. Acute rheumatism is the worst 
form of rheumatism, because of its danger to the heart, which it 
affects independently of the severity of the attack or the number 
of joints affected. Chronic rheumatism is a disease of middle or 
late life,, attacks the muscular tissues, and has no tendency to 
affect the heart. Salicylic acid has great power in diminishing 
the severity of the pain in acute rheumatism, and in reducing 
the swelling and inflammation, and therefore seems to be a spe- 
cific; but on examining the urine we find that the disease itself 
is not removed, nor is the liability of recurrence or heart disease 
prevented. Salicylic acid and its compounds simply relieve the 
symptoms, but do not cure the disease, and are therefore not 
specifics. 

One of the compounds of salicin, salicylate of soda, when 
given in doses of from gr. xv.-xx. about an hour after each 
meal, is an admirable cholagogue; and salicylic acid is a very 



DISINFECTANTS. 27 

valuable remedy in lumbago and other diseases dependent on a 
disordered liver (dose, gr. xv., t. i. d.), operating as an anaes- 
thetic and stimulating the secretion of the liver. 

Salol. — This substance is a combination of salicylic acid with 
phenol, making a salt with pleasant taste and fragrant odor. It 
is insoluble in the stomach, is not usually dissolved by the pan- 
creatic and biliary secretions, but, dissolving slowly in the in- 
testines, salol and salicylate of soda are very valuable reme- 
dies for intestinal fermentation, which brings up an important 
subject. Intestinal fermentation is something more than an 
accumulation of gases in the alimentary canal, for which char- 
coal may be given. In every hour of our lives, but particularly 
during the night, there are forming constantly in the intestines, 
by normal processes of fermentation, soluble alkaloidal sub- 
stances of a poisonous nature, which are absorbed into the por- 
tal circulation, and thus reach the liver, one of whose functions 
it is to destroy these poisonous products. If from any cause 
the liver is out of order, and so unable to destroy these poisons 
in the blood which passes through it, they pass on into the gen- 
eral circulation and give rise to very serious symptoms. More 
than fifteen of these poisons have been isolated, some of them 
resembling in their action atropine, aconite, curare, etc. 
Healthy urine, which contains several of these substances, is 
more poisonous than the urine of B right's disease, for the rea- 
son that, instead of being eliminated by the kidneys, they are 
circulating in the patient's system. It is now known that urea 
is not the cause of urcemia, for persons with uraemic symptoms 
do not always show a deficiency in the amount of urea excreted: 
but this disease is due to the presence in the system of these 
deleterious substances. Many cases of nervous ailments, such 
as hysteria, functional or intermittent headaches, severe neu- 
ralgias, are unquestionably dependent on the same cause, and 
here the treatment should mainly be to keep the bowels open 
and to disinfect the intestines. So also in those forms of epi- 
lepsy associated with intestinal symptoms, diarrhoea or consti- 
pation either preceding or following an attack, with offensive 
breath, instead of giving bromide of potassium, steady atten- 
tion should be paid to the disinfection of the intestines ; and 



28 NOTES ON MATERIA MEDICA. 

one of the best remedies for disinfecting the stomach is sali- 
cylate of soda, or, better still, salol. 1 

The other members of this series, some of them forming dis- 
tinct classes, possess many properties in common with the sub- 
stances just described, and may therefore be dealt with briefly. 

Oil of Wintergreen (Oleum Ganltheriae) was formerly 
regarded as an excellent tonic, and was of considerable use in 
the treatment of malaria, before the introduction of quinine, 
and of skin diseases dependent upon malarial infection. It is a 
very good remedy for toothache, as it contains a considerable 
quantity of salicylic acid, which has the ancesthetic properties 
common to the carbolic-acid series. In the treatment of chronic 
dysentery (which should always be antiseptic) oil of wintergreen 
is very valuable. In this disease, while something may be 
gained from treating the bowels topically, it is essential that 
the disinfection be local, as there are frequently ulcers in the 
rectum which, for obvious reasons, can never get well unless 
kept disinfected. Five or ten drops of oil of wintergreen or of 
oil of peppermint should be added to a quart of warm water and 
used as an enema to wash out the lower bowel after every move- 
ment. Frequently diarrhoea 2 and chronic dysentery, where 
the disease is near the exit, are cured in this way without the 
administration of any medicine. 

Oil of Peppermint (Oleum menthae piperitse), the most 
active principle of which is menthol, or mint camphor, is a mag- 
nificent antiseptic, being clean, pleasant, and having the 
property oi quickly alleviating pain. It is the best local remedy 
for phlegmonous irritation, and therefore should be used in the 
treatment of carbuncles. A paste made of oatmeal moistened 
with glycerin (or ordinary sweet oil) three parts, and oil of 
peppermint one part, is an excellent application for burns, as 
it relieves the pain very rapidly, prevents suppuration, and, unless 
the burns are deep-seated, obviates the formation of scars. Oat- 
meal itself is an antiseptic on account of its powerful drying 
properties. 

Benzoin. — This substance is obtained from a resinous tree 
(Styrax benzoin) growing in Java and the East Indies. Its 

1 For further uses of salicylic acid, salol, etc., see p. 37. 

2 For the clinical differences between diarrhoea and dysentery, see p. 159. 



DISINFECTANTS. 29 

compounds, called "balsams," contain the carbolic-acid prin- 
ciple, and therefore possess the ansesthetic and disinfectant 
properties of the carbolic-acid compounds. These balsams are 
traditional antiseptics. They are excellent deodorizers, and 
therefore used with other remedies in the treatment of wounds. 
The pain in bronchitis will be much relieved by the inhalation 
of these substances. 

Camphor. — Camphor is a stearoptene derived from Cinna- 
momum camphora, a tree growing in Malacca and other south- 
eastern parts of Asia, and may be made from ordinary hemp 
tops when in bloom. It is found also in pennyroyal and many 
other plants of this class which are destructive to insects and 
fungi. It is much more insoluble in the juices of the stomach 
than the balsam compounds, but more volatile, and, being an 
antiseptic, it is on this account specially useful in Asiatic cholera, 
cholera infantum, etc., because it is not dissolved in the stomach, 
but operates in the upper part of the intestines. Camphor has 
been the principal remedy for a long period in the treatment of 
diarrhcea characterized by watery discharges but unattended by 
pain — a most dangerous form, especially when it occurs in chil- 
dren. Large doses are poisonous, the symptoms being similar to 
those of carbolic-acid poisoning. 

Naphthaline. — This substance is also a derivative of coal tar. 
It is a good deodorizer, and, like other members of the turpen- 
tine class, is not dissolved until the large intestine is reached. 
It is a very efficient remedy in the treatment of chronic dysen- 
tery (dose, gr. i.-v.). 

/2-Naphthol is a compound of this drug. It should be given 
to hysterical patients with symptoms of intestinal fermentation 
(dose, gr. v.-x.). Rhubarb and benzoate of soda are also 
good remedies for this complaint. 

For Diarrhcea with Gout. 

5 Sodii Benzoatis 3 ij 

/?-Naphthol 3 ss 

Salol . 3 i 

M. Div. in capsulse No. xxiv. 

Sig. Two capsules after each meal and upon going to bed at 
night. 



30 XOTES OX MATERIA MEDICA. 

Thymol. — This crystalline solid is the most important con- 
stituent of oil of thyme, a powerful antiseptic. It is sometimes 
substituted for sal ol, naphthol, naphthaline, etc., and is espe- 
cially used in the treatment of various skin diseases. 

Chinoline. — This is a substance found in the alkaloids of 
cinchona, whence its name, and it is also derived from coal tar. 
Used externally it possesses the antiseptic and disinfectant pro- 
perties of the other compounds of this series. Internally it is 
used as an antipyretic, here being allied somewhat to quinine in 
its properties. The efforts within the last few years to make 
quinine artificially, though not successful, have resulted in the 
production of several compounds which have the power of reduc- 
ing a high temperature. Among the more prominent of these 
compounds are autipyrine and antifebrin, but the whole car- 
bolic-acid class possess the same property in a greater or less 
degree. It is questionable practice, however, to attempt to break 
the temperature in any kind of fever, for this reason: that the 
muscles, in addition to their mechanical function of producing 
the various movements of the body, are the chief heat-generat- 
ing tissues, furnishing four-fifths of the total bodily heat; and 
therefore fever is essentially a muscular disease, and one of its 
first signs is muscular weakness. 'Now, these drugs are muscular 
paralyzers, and consequently their administration increases the 
muscular weakness, and sometimes to such an extent as to pro- 
duce permanent loss of muscular strength. The application of 
cold as an antipyretic is therefore to be preferred, as it does not 
have this effect. Antipyrine and antifebrin are, however, useful 
in the treatment of headaches dependent upon intestinal fermen- 
tation, and for relieving rheumatic pains. They are the best 
remedies for the neurotic pains of locomotor ataxia, caused by 
some derangement of the nerve centres. "When used for this 
purpose, ammonia or salicylic acid should be added to the anti- 
pyrine or antifebrin, a combination of drugs of similar properties 
being more effective than one used alone. 

Chlorine Class. — The principal substances forming this class 
are chlorine, bromine, iodine, and their compounds. Their 
disinfectant properties depend upon their chemical affinity for 
hydrogen, which is so intense that under favorable circumstances 



DISINFECTANTS. 31 

they will decompose water in order to combine with the hydro- 
gen. They operate, therefore, in two ways: directly, by decom- 
posing water, and in that way destroying tissues in the same 
manner as lime does; indirectly, by the liberation of oxygen in 
the nascent state. This double action renders them, next to 
corrosive sublimate, the most powerful destroyers of tubercle 
bacilli, the action of corrosive sublimate itself as a disinfectant 
being in some measure due to the chlorine it contains. As 
antiseptic medicines they are in one respect superior to carbolic 
acid, as they may be taken in relatively larger doses, symptoms 
of poisoning never happening except when given in concentrated 
form. 

This class is particularly useful against gangrene and the 
specific communicable diseases. In gangrenous decomposition, 
which is a different thing from the decomposition of pus, there is 
a particular form of bacteria which can only be dealt with by 
the chlorine class, the carbolic-acid class being almost powerless. 
Different kinds of decomposition are produced by separate 
organisms, and a germicide effective against one form of bac- 
teria may be useless against another. Disinfectants of one kind 
are never universal, and lives have been sacrificed because of the 
erroneous impression that what has proved a disinfectant against 
certain agencies of disease must necessarily be so against others 
of a different character. 

Chlorine. — Chlorine can be obtained by taking equal parts of 
common salt and black oxide of manganese. To a tablespoonf ul 
of this powder, placed in a saucer, add a tablespoonf ul of strong 
sulphuric acid diluted (with water) one-third. This will pro- 
duce enough chlorine to disinfect a room thirty-two feet square. 
In cold weather the saucer should be heated, either by placing 
on the stove or over a lamp. 

After the chlorine has left the above compounds, the residue, 
which is also a disinfectant, maybe thrown into the water-closet, 
and this should especially be done in cases of typhoid fever to 
disinfect the stools and thus prevent them from becoming the 
source of infection. Chlorine, from its extreme pervasiveness, 
should be used in the disinfection of halls, passages, etc., in 
houses where any of the communicable diseases have been de- 



32 KOTES ON" MATERIA MEDIC A. 

veloped; for, while it may not destroy all the germs, it will 
greatly hinder their multiplication and so reduce the danger of 
infection. 

Chlorine in the form of Labarraque's solution (which is more 
pleasantly borne by the stomach than the chlorinated water of 
the Pharmacopoeia) is, when properly diluted, an admirable 
drink in all cases of specific communicable disease, especially 
when a gangrenous condition of the blood and secretions is be- 
ginning to be produced. The first indication of this is the ap- 
pearance of sordes on the lips and teeth, due to the exudation 
of decomposing blood through the mucous membranes. Fol- 
lowing this there will be high fever, very profound nervous 
prostration, rapid decomposition in intestines, which become 
tympanitic, and sooner or later an extremely offensive diarrhoea, 
and the whole body will be full of little emboli caused by the 
ante-mortem decomposition of fibrin. So also in malignant 
dysentery and bad cases of diarrhoea, not only are the discharges 
putrid, but the whole appearance of the patient shows him to be 
suffering from putrid intoxication. As soon as sordes appears, 
at once charge the system with as much of: these disinfectants 
as the patient can bear. Labarraque's solution should be given 
in doses of never less than 3 i.", and if diluted with water or milk, 
so as not to be locally irritant, 3 iv. may be given, and some- 
times even 3 vi. In all these exanthematous fevers (with the 
exception of typhoid), begin with the disinfection of the ali- 
mentary canal by a calomel purge, which, in the case of chil- 
dren, may be combined with jalap. After this has operated, 
the treatment should be Labarraque's solution in sweetened 
milk, given every two or three hours, or, in severe cases, every 
hour or half -hour. Where there is a very irritable condition of 
the stomach, it may be necessary to give paregoric to prevent 
vomiting. 

Bromine. — This substance is extremely destructive of all 
forms of microscopic life, more so than chlorine, and in fact it is 
the most powerful disinfectant in the world; for though corro- 
sive sublimate is more destructive, it loses its power by combin- 
ing with albumen. As bromine is very volatile, it is used with 
chlorine to disinfect the air and those parts of a building which 



DISINFECTANTS. 33 

cannot be reached by liquid or other disinfectants. It is the 
remedy par excellence for hospital gangrene, and is to be given 
in all cases where there is gangrenous development, especially 
in diphtheria. It is not a specific against this disease, but is a 
disinfectant to be used against its local manifestations and to 
prevent the infection from spreading. As soon as there are 
suspicious diphtheritic signs in the throat, touch every part af- 
fected with bromine in form of Smith's solution (a solution of 
bromine analogous to Lugol's solution of iodine in water. 
Take two ounces of a saturated solution of bromide of potas- 
sium; to this add slowly, with constant shaking, one ounce cf 
bromine; then add very slowly one ounce of water; four drops 
of this solution contain one drop of pure bromine), applying it 
very lightly with camel's-hair brush, using a new brush with 
every application (Smith's sol. 3 i., aquae 3 i.). The strength of 
the application should be increased if membranes have already 
formed; and if they are very large and the breath foetid, it may be 
necessary to apply the solution clear. Do not prevent the com- 
ing away of the membrane, and, on the other hand, do not at- 
tempt to remove it forcibly. This is very effective against the 
gangrenous odor, and it is successful where chlorate of potash, 
muriated tincture of iron, etc., fail, many of the other symp- 
toms being also relieved. There need be no hesitation in ap- 
plying the solution clear, as it is not a caustic. In the propor- 
tion of gtt. i. to water 3 i. it may also be used as a gargle. 
Internally have the patient take as much bromine as possible, one 
drop to drachm of sweetened water or milk every hour, and the 
bromine may be increased to two, three, or even four drops if 
the symptoms do not improve. Owing to its disagreeable smell, 
there may be some difficulty in getting the patient to swa!lo\r 
the first one or two doses, but afterward there will be less ob- 
jection to it than to any other disinfectant, and it does not, 
cause vomiting and is in no way debilitating. 

On account of its volatile property, and the inability to dis- 
infect the deepest recesses of the auditory canal by solid or liquid 
disinfectants, bromine should be used in the treatment of otor- 
rhcea, a difficult and often extremely dangerous complaint. A 
3 



34 NOTES OX MATERIA MEDICA. 

spray of one to four, to be gradually increased to equal parts, is 
to be used. 

Sulphur. — When burned, sulphur produces an irritating gas 
called sulphur dioxide, which was once used very commonly to 
fumigate houses, holds of ships, etc. Experiments have demon- 
strated, however, that this gas has very little power to destroy 
any form of bacteria, and so for the purposes mentioned is less 
effective than either chlorine or bromine in form of vapor. For 
fumigation of hospitals, holds of ships, etc., nothing is better 
than wood-smoke, which is a combination of a number of dis- 
infectants — charcoal, carbolic acid, acetic acid, carbonic oxide, 
etc. — and it certainly is to be preferred to sulphur dioxide. 

The sulphite of soda is used against the vomiting, which is 
due to the growth of a fungus plant (sarcinae ventriculi) in the 
stomach. The plants look like uncolored squares of a checker 
board. There are usually from three to six of them in a group. 
They are unfavorable in their significance, and are found nearly 
always in a low condition of the system, and notably in cancer 
of the stomach. 

It is also useful in the distressing inflammation of the mouth 
and throat accompanying plithisis. There appear white patches, 
like diphtheritic membrane, due to spores of the bacilli. This 
condition is accompanied by great sensitiveness of the parts, 
and the patients are distressed by the saliva which accumulates 
in the mouth. In these cases use as a gargle: 

TJ Sodii Sulphitis, 3 i. 

Aquse Menthae Piperitae, 1 i. 

M. 

A very effective way of sometimes applying it is in the form 
of a powder blown into the throat: 

3 Sodii Sulphitis, 3 i. 

Morphinse, gr. ss.-gr. i. 

M. 

Iodine. — The action and medicinal properties of iodine are 
very similar to those of chlorine and bromine. Internally, it is 



DISINFECTANTS. 35 

mostly used in the form of Lugol's solution/ a preparation which 
enables it to be administered without irritating the stomach. 

Iodoform, one of the principal compounds of iodine, is 
much used as an application to surgical wounds. It is a pow- 
erful deodorizer, but as it is now conclusively proven that as 
a germicide iodoform is almost valueless, its undoubted anti- 
septic properties must depend either upon its forming new com- 
binations on the surface of the wound, or else upon its destruc- 
tion of the poisonous products of septic infection found in the 
tissues, which enables the latter, weakened by their presence, to 
more effectually resist the malign assaults of the morbific germs. 

UNCLASSIFIED DISINFECTANTS. 

Boracic Acid. — This is a very useful surgical disinfectant and 
can be used with carbolic acid in the treatment of wounds. It 
depends for its disinfective properties upon its remarkable dry- 
ing powers, acting similarly to lime, but without its caustic and 
other disadvantageous properties. It may be used as follows: To 
boiling water add salicylic acid until a saturated solution is 
formed. To this add borax until no more is dissolved. Into 
this dip some oakum. After the oakum is dried, it will feel 
softer than before. When thoroughly dry, place the oakum over 
the wound, and over this a layer of cotton wrung out of a solu- 
tion of carbolic acid, one drachm to a pint of water. This dress- 
ing will remove all odor in about twenty-four hours. As the 
oakum is irritating, the edges of the wound and skin should be 
protected by flexible collodion. 

Boracic acid, not being irritating, is also very useful in the 
treatment of eczema. It is used by otologists in cases of otor- 
rhea, but has been said to cause fatal inflammation, owing to 
suppuration being stopped by the water of the tissues becom- 
ing absorbed. However that may be, it is a very good applica- 
tion, in strong solution, for mucous discharges from canals, and 
hence much used by gynecologists. It is soluble in twenty parts 
cold water, but only in three parts boiling water. 

Corrosive Sublimate.— See " Disinfection of Wounds/' p. 42. 

Permanganate of Potash. — This is a salt forming dark- 

1 For formula, see Iodine, p. 112. 



36 NOTES ON MATERIA MEDICA. 

purple, slender prisms, a powerful caustic if sufficiently concen- 
trated, non-volatile, and a rapid deodorizer. It is extremely 
useful for disinfecting the gangrenous odor of an open cancer, 
where a permanent or non-volatile disinfectant is desired, not, as 
in ordinary cases of gangrene, a volatile one such as bromine. 
Potassii permang. gr. x. to water 3 i. is a strong, irritant appli- 
cation, but does no harm to an open gangrenous sore. It is a 
very good remedy, in less strength, for some cases of offensive 
leucorrhcea and other vaginal discharges. It is also particularly 
good in ozcena, in the form of a powder (Bisrn, Carb. 3i., 
Potassii Perm. gr. i.) and blown into the nose. In some cases 
it may be used in the form of vapor (in strength of gr. x. to 5 i.), 
but is not so effective in this way, nor in form of Condy's Fluid, 
as the powder. 

USES OF DISINFECTANTS IN THE TREATMENT OF DISEASE. 

Disinfection of Special Diseases. 

Cystitis. — Most of the inflammations of mucous membranes 
are due to their having been bathed for a number of hours in 
some putrefying liquid, and cystitis is one of the diseases result- 
ing from this condition. Urine normally is perfectly aseptic, 
but if from any cause, e.g., alkalinity, it decomposes before 
leaving the system, an inflammation of the bladder results, and 
there will be found mixed with the urine pus and stringy mucus. 
The bladder should be thoroughly washed out with a disinfect- 
ant, using either a dilute solution of carbolic acid to which borax 
may be added, a 1:10,000 solution of corrosive sublimate, or, 
better than any, resorcin or quinine, the latter preferably. 
(Over or rapid distention of the bladder is to be avoided, as para- 
lysis, and consequent retention of urine, may result.) After the 
bladder has been washed until the water returns clear, an ounce 
of slightly saline water in which one grain of quinine has been 
dissolved should be injected and allowed to remain. On account 
of their disinfectant and anaesthetic properties any of the tur- 
pentine class of remedies may also be used in the disinfection of 
the bladder and for the relief of the pain of the inflammation, 
bucku being the best, as it is excreted freely by the kidneys and 



DISINFECTANTS. 37 

does not impart any odor to the urine. Salol is also an admir- 
able remedy in chronic cystitis, as during its decomposition in 
the body carbolic acid is evolved, which is taken up by the blood 
and excreted by the kidneys. Twenty or thirty grains a day of 
this substance will give a dark color to the urine. Naphthol 
may also be used, but it is not so effective for this purpose as 
salol. 

Dermatoses. — Owing to the morbid condition of the blood, 
and the activity of those universal microscopic agents which are 
ever ready to start up fermentative processes in any wound or 
lesion, many skin diseases are extremely difficult to heal, parti- 
cularly eczema and similar diseases where the protective char- 
acter of the skin has been to a greater or less extent lost. It 
is necessary, therefore, to treat these diseases antiseptically; and 
on examining prescriptions that have been used for generations 
in the treatment of skin affections, it will be found that the 
remedies have almost without exception been antiseptics, e.g., 
mercurials, balsams, turpentines, etc. The circulation in the 
system of ptomaines, the products of intestinal fermentation, is 
a very common cause of these affections, and therefore not only 
must the disease be dealt with by external local applications, but 
remedies must be given internally for the intestinal fermenta- 
tion. 

For skin eruptions with pruritus, and for the itching of piles, 
salicylic acid may be applied as a local application. For eczema 
a solution of salicylic acid (one per cent, increase to two per 
cent if not effective, and, where scaliness is present, to five per 
cent), to which borax has been added, should be used as a con- 
stant wash. Zinc ointment may be made more effective by 
adding to it salicylic acid. ytf-Naphthol is also very effective 
in the treatment of skin affections, solutions being of the 
strength of five per cent, a solution of ten per cent causing local 
irritation; but in such scaly affections as psoriasis it will be neces- 
sary to use strong applications. 

Boils and carbuncles (which are several boils that have run 
together) are external in their origin, being the result of atmo- 
spheric infection. Boils are not only contagious but auto-con- 
tagious, spreading over the patient until he is fairly covered with 



38 NOTES OK MATERIA MEDICA. 

them, and occasioning great mischief by generating pus. The 
treatment should be local, by cauterizationbeiore the formation 
of the vesicle, afterward by the injection of equal parts of car- 
bolic acid and glycerin into the centre of the boil. Oil of 
peppermint may be applied in the same way to carbuncles, the 
sinuses, if these exisfc, being also filled with the oil. Boils are 
the frequent accompaniment of diabetes, and there also seems to 
be a very curious connection between carbuncles and diabetes, 
patients with carbuncles frequently having sugar in their urine. 
These carbuncles, boils, etc., are very troublesome things to con- 
tend with in this disease, and should be dealt with as effectively 
and rapidly as possible, as there is danger from the burrowing of 
pus. 

Phthisis. — Tuberculosis is a disease due to an infection of 
the system by one of the forms of soil bacilli, which is not self- 
limiting in its development, but reproduces itself in the body in- 
definitely. To destroy its extraordinary vitality, it would be 
necessary to administer antiseptics of a strength which the pa- 
tient's system would be wholly unable to stand, and so against 
the tubercle bacillus little can be done. The fatality of phthisis, 
however, is due not so much to the tubercle bacillus — for this, if 
left to itself, would become encysted and so harmless, as shown in 
cases of tubercular peritonitis — but to its dangerous alliance with 
the staphylococcus pyogenes aureus, or pus-generating corpuscle, 
present in the ulcerative processes caused by the necessarily con- 
stant respiratory movements of the lungs when in an inflamed 
condition. The persistent use of medicinal antiseptics of the 
carbolic-acid class is therefore of benefit in the treatment of 
phthisis in no other way than to limit the amount of suppura- 
tion and suppurative ulceration. The lungs are very little 
affected by the inhalation of carbolic-acid vapor (though this 
may still be used for offensive breath), the internal administra- 
tion of creosote 1 being far more effective, as it is taken up and 
excreted by the lungs, carbolic acid being principally eliminated 

1 Creosote, a product of the distillation of wood tar, is an exceedingly com- 
plex substance, many of its constituents belonging to the carbolic-acid class, 
and consequently, in its disinfectant and anaesthetic properties, its actions 
closely resemble those of carbolic acid. — Ed. 



DISINFECTANTS. 39 

by the kidneys; and, moreover, creosote is better borne than car- 
bolic acid. It may be give a in either solution or pill form, and 
as much as the patient can possibly take, until he becomes 
nauseated, which shows that the proper dose has been passed. At 
the commencement, six grains a day may be given, the dose being 
gradually increased, which becomes decidedly effective if twenty 
grains can be taken. Not more than one grain should be given 
at a time. The pill form is preferable with bismuth, or in cap- 
sules, but creosote is better borne in liquid form, the taste being 
obviated by combining equal parts of syrupus zingiberis and 
elixir cinchona with the water. Other remedies, of course, have 
to be used in the treatment of phthisis, creosote being simply the 
chief pulmonary disinfectant. 

Typhoid Fever. — This disease might properly be termed 
enteric fever, because the chief seat of its development is in the 
intestines, and it is a question whether intestinal infection is not 
the chief factor. This seems to be proved by the fact that the 
relapses which occur after the patient has had a normal tempera- 
ture for some days, and which are so serious owing to his debili- 
tated condition, are mainly due to the indulgence in animal food, 
overtaxing a weakened digestive system and giving rise to in- 
testinal fermentation; this fermentation of digestive matter fur- 
nishing the soil for the growth of a second crop of typhoid 
bacilli reproduced from the first. This fever should be treated 
with intestinal antiseptics, one of the most effective being bis- 
muth, 1 an excellent local antiseptic for any purpose. If this 
treatment is not adopted, diarrhoea, dependent upon putrefac- 
tion of intestinal secretions, will be a, very frequent concomitant 
of the disease. From this it naturally follows that the matter 
of diet is extremely important in this and in all fevers; for 
whenever the body temperature is raised to a certain degree 
above the normal, there is an arrest of the secretions throughout 

1 The following is the usual prescription: 

5, Bismuthi subcarbonatis, gr. xl. 

Pepsinae saccharati, gr. xl. 

Acidi carbolici, gr. i-ij. 

M. Et ft. pulv. No. viii. 
Sig. One every three hours. 



40 NOTES OX MATERIA MEDICA. 

the body, but especially those of the alimentary tract, which have 
antiseptic as well as digestive properties. Hence in all fevers 
there is a tendency to intestinal fermentation and putrefaction 
(whether food is taken by the patient or not) leading to diarrhoea, 
produced by the excessive discharge of mucus due to the intesti- 
nal irritation. This is characteristic of typhoid fever; but in all 
chronic fevers there is a similar tendency to a loose, watery 
diarrhoea of a " pea soup" kind, as it is termed, and if the fermen- 
tation, etc., is not checked there will ultimately be ulceration 
of Peyer's patches — a very dangerous condition if disinfectants 
be not used. For this reason, the use of beef tea in fevers, an 
article of diet formerly almost universally administered, has now 
been abandoned from its tendency to putrefy. Moreover, it 
possesses no nutritive power, being simply a stimulant made from 
the flavoring substances of meat. Milk is the only article of 
food that should ever be given to a typhoid-fever patient, and 
even here it is important to remember that in all fevers, notably 
in typhoid fever, the stomach is reduced to the weakness of in- 
fancy; and as an infant cannot digest milk as such, neither can 
a typhoid-fever patient. It must, therefore, be diluted, prefer- 
ably with an antiseptic, lime-water serving admirably for this 
purpose, as lime is both a local and medicinal antiseptic. Equal 
quantities of milk and lime-water should be used, and frequently 
given to the patient in small quantities throughout the twenty- 
four hours. Pepsin may be combined with it, as it prepares the 
food in a natural way, and thus prevents it from remaining undi- 
gested in the stomach, and is also decidedly antiseptic, being a 
virulent poison against many forms of bacteria. 

Wounds. — Where tissues are injured or destroyed, the skin 
however remaining unbroken, there will be various changes of 
appearance, swelling, absorption, etc. ; but if the pacient is in 
good health, the wound will rapidly heal without any fever or 
inflammation, no matter how extensive the laceration may be. 
But if the wound communicates with the open air, there will be 
inflammation and suppuration, traumatic fever will set in, and 
not uncommonly severe systemic disturbance, indicative of the 
absorption of some form of poison, will follow. All of these 
symptoms are due to the infection of the open wound by bac- 



DISINFECTANTS. 41 

teria. In order to imitate nature as far as possible, surgeons 
now place a protective covering over these wounds, first destroy- 
ing with a local antiseptic whatever atmospheric germs may 
have permeated the tissues. If the treatment be perfectly anti- 
septic, there will be no tendency to inflammation or purulent 
discharge, union without suppuration being the triumph of 
modern surgery. 

Carbolic acid is the leading surgical disinfectant. This 
substance is not only a powerful antiseptic, but is soluble in 
living tissues and organic fluids, which gives it in many cases 
an advantage over other disinfectants. For instance, a strong 
solution of corrosive sublimate, a far more powerful germicide 
than carbolic acid, is not nearly so effective as the latter in 
destroying the bacilli swarming in the sputum of a phthisical 
patient, because it combines with the albuminous constituents 
of the sputum (to form an albuminate of mercury), which car- 
bolic acid does not. Although very soluble in oil, carbolic acid 
is more effective in a watery solution, and hence the use of 
carbolized oil has now been abandoned. All forms of bacteria 
may easily be destroyed by comparatively weak solutions of 
carbolic acid or corrosive sublimate. The destruction of the 
spores of bacteria is unfortunately not so easily effected, as they 
possess an amazing vitality, far greater than that of the bacteria. 
If, however, the bacteria be destroyed in sufficient number, the 
production of spores will be diminished, but the fact that there 
are spores will necessitate the continuance of disinfective mea- 
sures in the hope of lessening their chances of growth. 

For an open wound, the strength of the solution of carbolic 
acid (which should always be in water, not in oil or alcohol) 
should be from one in forty to one in twenty, the latter strength 
preventing the multiplication of spores for two or three days. 
After the wound has been cleansed with the solution, apply the 
coverings as follows: (1) a protective covering of oiled silk, cov- 
ered with a coat of varnish made of dextrin, starch, glycerin, 
etc., to render it impermeable to carbolic acid and as an addi- 
tional antiseptic, and around the- edges of the covering a cream 
of salicylic acid and glycerin may be applied; (2) layer upon 
layer of antiseptic gauze, i.e., gauze which has been saturated 



42 NOTES ON MATERIA MEDICA. 

with carbolic acid, to which may be added salicylic acid and 
borax; (3) an india-rubber cloth; (4) a cloth dipped in a solution 
of one drachm of carbolic acid in a pint of water. If these pre- 
cautions are taken, and the surgeon's hands, instruments, etc., 
thoroughly disinfected, the mortality from surgical operations 
will be very small. The strong smell of carbolic acid, which is 
disagreeable to some persons, may be removed by adding to it oil 
of cinnamon or oil of wintergreen. 

Next to carbolic acid, corrosive sublimate is the only sub- 
stance to be recommended for surgical disinfection. In prevent- 
ing the initial infection of a wound, corrosive sublimate is more 
powerful than carbolic acid, and therefore is to be preferred as 
a first application in cases where, from exposure of the wound, 
germs are present in great numbers, and notably where the 
wound or surface is within a cavity, as in abdominal operations. 
As a continuous application it is not to be recommended, as it 
may cause death by poisoning. The strength of the solutions 
should vary with the size of the wound; the larger the wound the 
less the strength, because of the danger of poisoning by absorp- 
tion. The strongest solution for any wound at commence- 
ment should only be 1:10,000, and for a wound with a large 
surface the strength should be less. A solution of 1:40,000 is 
quite sufficient to destroy, not the spores, but everything in the 
shape of bacteria themselves. 



PART II. 



MEDICINAL REMEDIES. 



MEDICINAL REMEDIES. 



A medicine is a remedy which cannot act until it has entered 
the circulation in a state of solution. By circulation is meant 
not only that of the fluids contained in the blood-vessels and 
lymphatics, but the extra-vascular or interstitial circulation. 
The latter circulation, which is supplied by the exudation of the 
plasma of the blood and ultimately enters the lymphatic system, 
is a most important factor in the processes of nutrition and mole- 
cular interchange, and is the most important of all the circula- 
tions. That it is in nearly as rapid movement as the blood itself 
is shown by the quick diffusion of hypodermatic injections. 
Many remedies which seem to be medicines are not so, from be- 
ing used in a non-medicinal way. Thus nitric acid, given as 
a tonic to improve the appetite and aid digestion, acts as a med- 
icine; applied externally as a caustic, its action no more resem- 
bles that of a medicine than that of the actual cautery. By a 
medicine, therefore, we mean that we have a remedy that has 
become part either of the blood or interstitial fluid, and is act- 
ing in a molecular way either upon the secretive processes of 
nutrition or upon some function of the nervous system; and, 
therefore, such remedies as cold, heat, counter-irritants, blisters, 
caustics, electricity, baths, massage, etc., which act without en- 
tering the circulation, are not medicines. 

It is of the first importance in giving a medicine to get it as 
soon as possible into the blood or interstitial circulation, so as to 
have it dissolved (if this has not been done before administra- 
tion) and carried all over the body. Hence a medicine does 
not act locally, as it becomes a part of the general system as 
soon as it enters the circulation. 



46 NOTES ON MATERIA MEDICA. 

The principal avenues for introducing medicines into the cir- 
culation are: (a) various portions of the alimentary canal; (#) 
the skin; (c) the respiratory passages; (d) the subcutaneous 
areolar tissue. Of these the alimentary canal is the avenue 
most commonly chosen, but is inferior in many respects to that 
of the subcutaneous areolar tissue by hypodermatic injection, a 
method which unfortunately cannot always be used. 

(a) Various Portions of the Alimentary Canal. 

1. The Mouth. — That absorption may take place from this 
portion of the alimentary canal, if soluble substances are held 
in contact with the mucous membrane long enough, is proved 
by the fact that drugs used as gargles may sometimes be de- 
tected in the urine and other secretions. Oroton oil, placed 
on the tongue of a comatose person, produces purgation with 
almost as much certainty as if introduced into the stomach. 
Permanent discoloration of the skin of the face has been pro- 
duced by merely applying nitrate of silver to the throat contin- 
uously for two months. This method of administering medi- 
cines is now rarely used, except in those cases where deglutition 
is totally suspended. 

2. The Stomach and Small intestine. — Medicines, generally, 
are introduced into the stomach, as this is the most available 
and surest way. There are certain points to be remembered in 
giving medicines which are to be absorbed by the stomach or 
acted on by its secretions. One is, that the alimentary canal has 
various secretions which are never called into action simultane- 
ously, but successively ; another, that digestion and absorption 
are two distinct processes, and absorption never takes place to 
any extent while digestion is active. Non-nutrient medicines, 
especially of the neurotic class, lose a great deal of their efficacy 
in passing through the alimentary canal, from their modification 
by the remarkable solvent process of the digestive secretions. 
Therefore, all medicines which the alimentary canal does not 
immediately absorb that are of vegetable origin, especially those 
whose active principles are alkaloids, 1 should always be given 

1 An alkaloid is a definite chemical substance of organic origin, alkaline in 
reaction, and called an alkaloid because it resembles an alkali in chemistry, 



MEDICINAL REMEDIES. 4? 

when the digestive processes are least active, or else adminis- 
tered by the rectum, otherwise they will be so changed as to be 
no longer capable of producing the same action as when intro- 
duced directly into the interstitial circulation. On the other 
hand, certain medicines of the restorative class should be given 
an hour or two after a meal, as they are to be digested in the 
intestines. An important fact to be considered in this connec- 
tion is, that whatever is absorbed from the alimentary canal, 
passes into the portal system and is filtered through the liver, 
before it enters the general circulation. If, therefore, the liver 
is embarrassed in its functions, medicines given by the alimen- 
tary canal will be delayed in their action, and there will also be 
great loss. Hence in hot climates, where the portal circulation 
is generally slow, larger doses have to be given than in climates 
where this circulation is more active; and in all cases where med- 
icines are to be given by this channel, it is very important that 
this circulation shall be in its normal state of activity. For 
example, a sharp, purgative dose of calomel given before the ad- 
ministration of quinine will often enable the latter to operate 
successfully, where double the amount had previously been 
given without any effect; for quinine, if subjected to long de- 
lay in the alimentary canal, being an alkaloid, is very easily 
altered in its composition. (The quinine should not be given 
till after the movement has occurred.) Attention to this fact 
is still more important if there is gastritis dependent on the 
hepatic engorgement. In remittent fever of malarial origin, if 
there is vomiting and tenderness over the stomach, even large 
doses of quinine, given by the mouth, are markedly ineffica- 
cious until the gastric irritability has been allayed. For the 
same reason, if there is liver disease, the treatment of dropsy by 
diuretics frequently fails, the presence of fluid in the abdomen 
hindering still further the operation of these remedies. There- 
in that it is capable of combining with acids to form salts. Unlike an al- 
kali, however, the salts so formed have the same physiological and thera- 
peutic action as the alkaloid itself. The preparations of the drugs from 
which the alkaloids are obtained may vary in strength, but not the alkaloids 
themselves, which are always of the same strength, and hence are said to be 
definite. 



48 NOTES ON MATERIA. MEDICA. 

fore, in this condition, a:i ointment of mercury and digitalis, 
rubbed in through the skin to cause purgation, should first be 
used, and the diuretic administered after it has acted. The 
unsuccessful treatment of chlorotic women by the exhibition of 
iron furnishes another example. Iron is the remedy to be 
given; but where the intestinal and liver secretions are all in 
abeyance, the iron is not absorbed, and consequently there is no 
beneficial result. Very often this suspension of the secretions is 
caused by persistent irritation of the ovarian plexus, and when 
this has been overcome, 1 and cathartics are given once or twice 
a week, the administration of iron will be successful. These 
examples have been given, to emphasize the necessity of ascer- 
taining the powers and limitations of the alimentary canal, be- 
fore choosing it as an avenue for administering medicines. 

3. The Rectum. — Under certain conditions it becomes ne- 
cessary to administer medicines " per rectum n in the form of 
enemata. The following precautions are to be observed: (1) if 
there is portal congestion, it must be relieved before the ad- 
ministration of the enema, as it hinders absorption; (2) the 
enema must be in a state of solution, as there are no digestive 
secretions in the rectum, hence cod-liver oil (unless in a state of 
fine emulsification) and iron are not to be given; (3) the enema 
must not be a local irritant; (4) neither should it be an astrin- 
gent, as, if it is, it will not be absorbed, therefore tannin and 
some of the salts of iron are not to be given; (5) as a vehicle 
pure water is to be preferred, starchy liquids impeding absorp- 
tion and necessitating a much larger dose of the medicine than 
when given by the mouth; (6) the smaller the quantity the bet- 
ter: not more than a fluidounce should ever be given at one 
time, as over-distention excites the peristaltic and expulsive ac- 
tion of the rectum. 

When the rectum is available, enemata are used: .. (1) where 
it is desirable to spare the stomach on account of its exceed- 
ingly irritable condition, as in gastritis; (2) for the administra- 
tion of nourishment, where, owing to disease or other causes, 
the ordinary channels cannot be used; in these cases pep- 

1 See Constipation, p. 231. 



MEDICINAL REMEDIES. 49 

tonized milk, and beef -tea and white of egg that have been dis- 
solved in milk, and peptones should be given; (3) where only 
the local action of a medicine is desired. The benefits of this 
local action are that in giving medicine by the rectum, we have 
surer and better effects upon pelvic diseases. Thus in irritable 
stricture of the urethra, where a catheter cannot be passed, 
aconite given by the mouth will fail to give any relief, but if 
given by the rectum a catheter may be passed almost at once. 
So also in all cases of severe dysmenorrhcea, cystitis, etc., rec- 
tal medication is to be preferred, as it does not occasion any con- 
stitutional disturbance and gives relief. Suppositories may be 
used instead of liquid medicines, and, as these dissolve slowly, 
larger doses may be given. Thus in solution only one-quarter 
grain of ext. belladonna can be given; in form of suppository 
we may give one grain. 

(b) The Skin. 

Medicines in aqueous or alcoholic solutions are absorbed by 
the skin, only in very minute quantities and with great diffi- 
culty. If, however, fats or oily matters, in the form of oint- 
ments or liniments, are used as vehicles, medicines can very 
readily be introduced into the system, especially if their absorp- 
tion is assisted by friction. This method is of special use : (a) 
in inflammatory conditions of fibrous structures capable of 
being reached through the skin; (b) where the deeper layers of 
the skin itself are involved, as in syphilitic diseases of the skin; 
(c) in rheumatic inflammations, where the sheaths of muscles 
surrounding joints, have a tendency to thicken; (d) for the 
treatment of enlarged lymphatic glands j (e) for the treatment 
of epididymitis which is causing thickening of affected tissues:. 
(/) for diseases of spinal cord, dependent upon local inflamma- 
tion; ( g) for the vascular thickening and inflammation follow- 
ing sunstroke; in cases of this kind, and for diseases of the 
spinal cord where this method is to be used, the oleates, oint- 
ments, etc., must be rubbed in along the spinal cord, which 
can also be reached through the great nerves; (h) constitu- 
tional syphilis. In treating this latter disease by inunction, the 
4 



50 NOTES ON MATERIA MEDIC A. 

skin should be thoroughly washed, to secure easy absorption, and 
the ointment should be applied to different parts of the body, 
instead of confining it to one place. This treatment has been 
very successful in some of the most obstinate cases, where the 
patients had been taking mercury by the mouth, for years, with- 
out avail. 

Vapors of all kinds are very readily absorbed through the skin. 
The quickest way to bring a patient under the influence of mer- 
cury, is by means of the mercurial vapor bath. A volatile in- 
gredient in a liniment or ointment will aid the absorption of the 
other ingredients. 

(c) Respiratory Passages. 

Medicinal agents are taken into the circulation, from the 
mucous membrane of the respiratory tract, when given in the 
form of medicated watery vapor, as in sprays; in powders by in- 
sufflation, and by absorption of gases and vapors, such as ether, 
chloroform, etc., by the lungs. 

(d) Subcutaneous Areolar Tissue. 

Medicines are introduced into the interstitial circulation direct, 
either by means of a hypodermatic syringe and needle, or, if these 
instruments are not available, by raising the cuticle by means of 
a blister and applying the remedy to the raw surface, as it is 
readily absorbed by the lymphatics of the skin. The substances 
used must be perfectly soluble, and, if possible, not locally irri- 
tant. Quinine, unfortunately, causes local irritation which fre- 
quently ends in troublesome abscesses. Various attempts have 
been made to avoid this by modifying the preparations, but so 
far without success. Six to eight grains of quinine given by this 
method produce as much effect as thirty given by the mouth. 
The advantages of hypodermatic medication are: (1) The small- 
ness of the dose necessary, it being one-fourth of that given by the 
mouth. (2) Certainty of action, as nothing of the drug is lost 
before entering the circulation, and therefore we know exactly 
how much will actually operate. (3) Rapidity of effect. Instead 



MEDICINAL REMEDIES. 51 

of waiting for the process of absorption to be completed, we have 
an almost instantaneous effect, the medicine being all over the 
body in less than twenty seconds. (4) Localized action. This 
method enables us to use drugs for local purposes and to limit 
their action, as with cocaine, where only a limited anaesthesia is 
required. 

In a few instances, a drug given hypodermatically produces re- 
sults different from those following its administration by the 
mouth. Thus, with morphine, for example, the abandonment of 
the use of the drug by a patient who has been accustomed to 
take even large doses by the mouth is not followed by any ill 
results. There will be an intense craving for the drug, but the 
constitution is uninjured, and there is no intestinal disturbance. 
If, however, the drug has been given hypodermatically for any 
length of time, the cessation of its use is followed by an uncon- 
trollable diarrhoea which in some cases has ended fatally. (Dose 
of drugs given hypodermatically, one-fourth of that given by 
mouth, to be increased as the patient becomes habituated to its 
use.) 

Medicines are divided into two classes :' I. Organic or Disease 
Medicines. II. Functional or Symptom Medicines. 



I.— ORGANIC OR DISEASE MEDICINES. 

These are medicines which act upon and modify the tissues or 
fluids of the body, so that after their action the system is not in 
the same state that it was before their administration. They 
may be divided into : (1) Restoratives ; (2) Alteratives. 

The Restorative medicines are : 

1. Cod-liver oil. 5. Vegetable bitters. 

2. Iron. 6. Mineral acids. 

3. Phosphorus. 7. Alkalies. 

4. Quinine. 8. Mineral waters. 



1 For the distinctions in character of these two classes, see Classification 
of Medicines, p. 1. 



52 NOTES ON MATERIA MEDICA. 

Class I. — Organic or Disease Medicines. 

Division I. — Restoratives, 

General Character. — Eestoratives are medicines which are 
natural to the system, either because they are themselves ingre- 
dients of the body or analogous thereto. They act by supplying 
some deficiency in the system, and. are therefore of the nature 
of foods. Hence they are most beneficial where there exists 
some form of starvation, and correspond to an extremely com- 
mon condition of the system, characteristic of all morbid states, 
viz., deficiency of nutrition due to mal- or non-assimilation. 
This is particularly the case in fevers, and many of the symp- 
toms of typhoid and other fevers will be explained by remem- 
bering that the patient is suffering from want of food. How to 
feed the patient is a greater problem than almost anything else, 
and the same question arises in other morbid conditions. More- 
over, it is necessary that the restorative medicine shall corre- 
spond to the deficiency in the system. There are cases in which, 
a particular source of food failing, there is a corresponding de- 
ficiency in the power to do a certain kind of work. Hence if, 
for example, the loss be that of muscular power, iron is indi- 
cated; if it be that of nervous power, cod-liver oil, phosphorus, 
etc., are indicated. Lastly, these medicines must not be dealt 
with as if they were drugs. To be efficacious they must be appro- 
priated by the system; for whenever these medicines do good, 
it is because the patient needs something corresponding to them, 
and which he does not have in his system from some failure of 
the nutritive processes. 

I. Cod-liver Oil (Oleum Morrhuse). 

Cod-liver oil is obtained from the fresh liver of the cod, G-adus 
morrhua. In the hepatic cells of the cod it is limpid and 
very fluid, resembling an ether. As prepared it should have a 
pale yellow color, slight fishy odor, and should develop, on the 
addition of sulphuric acid, a violet color passing quickly to a. 
yellowish or brownish red. 



MEDICINAL REMEDIES. 53 

Oil is a necessary ingredient of food, for if animals are de- 
prived of it, ulcerative degeneration results from imperfect nu- 
trition of the tissues. Oil is also a great source of power or 
force, its main function in the system being to furnish energy. 
Bulk for bulk, it furnishes more force than any other article of 
food. Accordingly, we find that fat is stored up in the cells of 
all tissues which have to do a great deal of work. In the more 
inorganic tissues, such as cartilage, not much fat is stored up; 
but where, as in embryonic tissue, the cells are actively engaged 
in the processes of growth, a very large supply of fat is needed 
and supplied. Muscle cells require more fat than secretory cells, 
and nerve cells more than muscle cells. Proportionately, there 
is more fat in nerve tissue than in all the other tissues put to- 
gether. Fat does not enter into the formation of new tissue, 
except abnormally, when the process is called " fatty degene- 
ration/' The power generated from oil is used according to 
function, and, the highest function of all being that of the nerve 
tissue, we should a priori come to the conclusion that where its 
nutrition is defective, something of a fatty nature is required 
rather than albuminous or other forms of food. 

The operations of the nervous system are vastly more complex 
than those of all the other tissues put together. For example, 
contraction and relaxation complete the functions of muscular 
fibres. Not so with nerve cells. All the different functions of 
the body, special senses, etc., are presided over and carried on 
by them. There is no part of the body without its correspond- 
ing nerve ganglion. All the rest of the system is merely acces- 
sory or subsidiary to the nervous system, which therefore uses 
the most food and requires the greatest amount of fat. But fat 
is not easily digested or assimilated. It is emulsified in the di- 
gestive tract only after great difficulty, and even then is not 
ready to be used. It must be sent to the liver before it can be 
assimilated by the system, as this organ has more to do with the 
conversion of fat into blood food than any other. Warm- 
blooded animals use up fat quickly, but fishes that live in deep, 
cold water are supplied with a reservoir of fat, as it were, in their 
liver cells. On examining this oil we find it to differ from that 
found anywhere else, in that it flows like water, is readily diffu- 



54 NOTES ON MATERIA MEDIC A. 

sible through animal membranes, and, when subject to capillary 
attraction, rises higher than any other oil. It is elaborated 
fat, digested and ready for use, and this at once explains its 
valuable properties. This fat is the best and most digestible of 
all foods. If albumen in its simplest form — i.e., white of 
egg — be injected into the blood, it will at once be sent to the 
kidneys and excreted as a foreign substance, because, not having 
been prepared by the liver, the system cannot use it. So with 
fats. The great problem in giving them is how to get them di- 
gested, and the same question arises with the other medicines of 
this class, e.g., iron, which, often given in a very routine way, is 
extremely difficult of digestion, and unless assimilated is not 
only absolutely useless, but will tend to irritate the patient. 

Cod-liver oil was first discovered to be a ready-made food em- 
pirically. In 1754, Dr. Percival wrote a book on the uses of cod- 
liver oil in the treatment of rheumatism. He had lived in sea- 
port towns where there were a large number of whalers and fisher- 
men, and found that for generations they had been accustomed 
to use cod-liver oil in the treatment of rheumatism — a complaint 
which, owing to their occupation, is very common among them. 
They knew it softened leather and concluded it would soften stiff 
joints and act in a similar way internally. To this day cod- 
liver oil is the best remedy for chronic rheumatism. In 1829, a 
treatise was published showing that cod-liver oil was good for skin 
diseases of rheumatic origin, but it was not till 1843 that it was 
first used in the treatment of phthisis. We now know that it is 
the remedy of all remedies to give in diseases of the nervous 
system, and is the great preventive of a number of serious dis- 
eases, and finally it can be given for many conditions not sup- 
posed possible when confined to empiricism. What does it do 
when it acts beneficially ? In 1848 and 1849, it was noted by 
Simon that, after giving cod-liver oil beneficially, the most nota- 
ble result was the engorgement of the blood with red corpuscles. 
This is a fact, as it is better than iron or any other known 
medicine for this purpose whenever it acts in this way — in other 
words, when specially needed. Diseases that result in anaemia 
will show better results with cod-liver oil than with anything 
else. Iron also relieves anaemia, but cod-liver oil produces double 



MEDICINAL REMEDIES. 55 

the effects of iron, and it should always be given in febrile dis- 
eases, and in many cases of debility where there is no fever. Red 
corpuscles are living cells of very rapid growth and decay. It may 
be said advisedly that we do not know where they come from, as 
such a highly organized substance cannot come from the many 
different sources given by physiologists. Not a single function 
of the body would get on for an instant without them, except 
perhaps the hair and nails. There is this fact about them that 
is a mystery, viz., their rapid destruction, although so necessary 
to the system. In a healthy man there are about 5,200,000 
of them in a spaco no larger than a pin's point. A single night 
of nervous strain will reduce them to less than 1,500,000. Hence 
the pale countenance produced by anxiety. Consequently the 
question may arise as to whether the increase of red blood-cor- 
puscles, resulting from the administration of restorative medicines, 
is real or apparent only. Has there been an actual increase of red 
corpuscles, or merely prevention of their destruction ? Corrosive 
sublimate and arsenic act apparently in the same way as cod- 
liver oil, for the blood of a healthy person to whom either of 
the two former drugs has been administered for a week will be 
found to be richer in red corpuscles. Corrosive sublimate and 
arsenic, however, operate by preventing or delaying the destruc- 
tion of the corpuscles by rendering them more unsusceptible to 
the influence of the nervous system, and the persistent use of 
these drugs will lead to the suspension of those normal pro- 
cesses of the liver, owing to its fatty degeneration, which destroy, 
in common with other organs, the red corpuscles of the blood. 
Cod-liver oil and iron, on the other hand, increase the formation 
of red corpuscles. 

The tissues of the body which suffer most from defective 
nutrition and which are most benefited by the administration 
of cod-liver oil are (1) nervous tissue, owing to its incessant and 
varied activity; (2) growing tissue, which needs more fat than 
tissue which is not growing; and (3) active tissue of any sort, 
muscular or secretory. 

The processes of decay and death are constantly going on in 
the body, so much so that life has been defined as the sum total 
of the forces which resist death. But there are certain constitu- 



56 KOTES ON" MATERIA MEDICA. 

tional changes characteristic of different periods of life. Old 
age, for instance, is a true disease. If the body be examined 
carefully for all changes from the normal, there will be found 
certain degenerations characteristic of declining vitality, which 
resemble in most of their important features those found in the 
body of a man who has died prematurely from the excessive use 
of alcohol. Special diseases belong to changes of constitution 
at middle life and at other periods. The greatest fatality is in 
the first year of life, and the next greatest from the end of the 
first year to the commencement of the sixth. This relation of 
disease in children to a particular time of life, is one of the most 
important of all the subjects of therapeutics, for it indicates, 
that many diseases of children are dependent upon conditions 
they cannot escape. 

1. The Uses of Cod-liver Oil in Diseases of Children. — It has 
already been stated that the liability to disease and death is very 
great in the quinquennial of life between the cessation of lacta- 
tion and the end of the sixth year. In the first year of life, 
which has the greatest fatality of any year, the deaths are mainly 
due to difficulties of digestion. In the five years that follow, 
there are many special diseases, that are the direct result of the 
extremely rapid growth of the human brain during this period, 
which is paralleled nowhere else in the system, except by the 
growth of the pregnant uterus. The growth is not only in bulk 
but in function, so much so that the nervous system of a child 
has proportionately a greater strain upon it than that of an 
adult, and moreover responds to it. In learning languages, in 
the acquisition of new ideas, in the formation of conceptions, 
judgments, etc., the child's brain does better work than it ever 
will at any subsequent period. This rapid growth of the brain, 
which at the end of the sixth year has almost attained its full 
weight for the rest of life, is the cause of a great many disasters. 
The reason is that this organ, even in adult life demands, one- 
fourth of the blood of the body, but in childhood one-third is 
required. Consequently the rest of the system must wait until 
the nervous system is supplied; for in experiments upon animals 
it was found that the last tissue to suffer from the effects of 
starvation, was that of the nervous system, the disappearance of 



MEDICINAL REMEDIES. 57 

adipose tissue taking place first, followed by the bones, carti- 
lage, epithelial and connective-tissue structures, and to a less 
extent the muscular system losing both in volume and weight. 
Hence it is that, from inability to supply the necessary amount 
of nutritive material, there are thousands of children that can- 
not survive this critical period of life. The indications of failure 
of nutrition in children assume many different forms, but they 
can all be traced to the fact that the affected tissues are not fed 
because the nervous system is taking so much. If enough 
nutriment be supplied to more than satisfy the latter, these ill 
effects will mostly disappear. By acting on these principles, 
many a child may be saved from scrofula, etc., and perhaps 
death. Scrofula is a disease characterized to the ordinary ob- 
servation by inflammation and frequently ulceration of the 
lymphatic glands, with a tendency to disease of bones, chronic 
catarrh of mucous membranes, enlarged tonsils, excessive ner- 
vousness, otorrhcea, etc. 

All these symptoms can be explained by the fact that the 
richer tissues are being fed at the expense of the poorer, i.e., the 
more non-vascular, such as cartilage, etc. It is to the latter, 
therefore, that we must look for the first indication of defective 
nutrition. Hence the cornea, composed mainly of cartilage, is 
early affected, a little ulcer forming in the centre of a fan-shaped 
enlargement of veins. If the hair be examined, it will be found 
very flaccid and easily breakable, most of the cylinders being 
very slender. The next to suffer is the skin, which, instead of 
being smooth and soft, as a child's skin should be, has the rough- 
ness of that of an adult, notably so on the legs and chest. It may 
be laid down, therefore, as a rule that, unless caused by acute dis- 
ease, a rough, harsh skin predisposes to mucous catarrh, a case 
of bronchitis rarely occurring without it. Now comes this fact: 
wherever mucous membranes inflame and ulceration occurs, the 
inflammatory irritation is immediately communicated to the 
nearest lymphatic glands, resulting in the disease known as 
adenitis — an inflammation of the lymphatic glands that is the 
necessary result, and always in the track, of an ulcer. Hence 
inflammation of the urethra or vagina enlarges or inflames the 
inguinal glands. Scrofula, however, does not immediately tend 



58 NOTES OK MATERIA MEDICA. 

to adenitis, but to ulceration of the skin and mucous mem- 
branes, and so many of these scrofulous children have sores upon 
the scalp, especially in the second and third years of life. Let 
this condition go on unchecked, and, the system being neces- 
sarily open to many infections from without, the child in a few 
years will probably succumb to- tuberculosis. Scrofula is not an 
infection in itself ; tuberculosis is. The former is a negative 
disease, dependent upon failure of nutrition ; the latter is posi- 
tive, dependent upon specific infection from without. But this 
failure of nutrition in scrofula predisposes to tuberculosis. 

The diseases resulting from a scrofulous diathesis may be 
averted by properly feeding the child, the food being that which 
nature has indicated. The singular liking of most children for 
cod-liver oil is an indication that it satisfies an instinctive crav- 
ing for that form of food — a craving which will cease as soon as 
the condition which gives rise to it passes away. Therefore 
cod-liver oil is to be given to prevent ulcerative diseases of the 
eyes, ears, nose, and throat, the cuticle, and especially the 
scalp; the tendency to asthma, etc., on account of weakened 
mucous membranes, including that of the nose; convulsive dis- 
eases like epileosy : and, in the great proportion of cases, tuber- 
culosis. 

2. The Uses of Cod-liver Oil in Rheumatism. — Cod-liver oil 
is not of much use in the treatment of acute articular rheuma- 
tism, but does a great deal of good in the chronic form, probably 
by increasing the nutrition of the skin; for, though the state- 
ment may not be found elsewhere, rheumatism is essentially a 
skin disease. This view is based upon the climatological fact that 
chronic rheumatism prevails most in those countries where the 
skin, after being covered with moisture, is subsequently chilled. 
Hence in wet- countries like Norway and Sweden, the north of 
Scotland, etc., where fishing is the principal industry, rheuma- 
tism is very common; and, strange as it may seem, it also pre- 
vails extensively in very dry climates, provided they are very hot, 
such as the deserts of Sahara and Arabia. The explanation of this 
paradoxical fact, is that in these deserts the days are very hot, 
and, owing to the absence of all vegetation, the radiation of heat 
during the night is very rapid, and hence, unless proper precau- 



MEDICINAL REMEDIES. 59 

tions are taken, the skin will he covered with perspiration during 
the night, and, the person becoming chilled in the early morn- 
ing, rheumatism results. Therefore, for the successful treat- 
ment of rheumatism, particular attention should be paid to the 
skin, which is often extremely sensitive. Cod-liver oil diminishes 
this sensitiveness and relieves the rheumatism, and it is the best 
remedy for rheumatic constitutions. 

3. The Uses of Cod-liver Oil in Nervous Diseases. — The ad- 
ministration of cod-liver oil in neurotic affections, by giving the 
nervous system a better supply of force-producing material, 
lessens the liability to nervous derangement, and so it should be 
classed as one of the greatest remedies for nervous diseases. 
It does not act as a specific, but, by increasing the strength of 
the patient, it enables him to contend more successfully with his 
morbid tendency. True nervous diseases, such as epilepsy, and 
notably those that are hereditary, such as neuralgia, megrim, 
etc., may be very successfully treated by combining with other 
remedies, such as bromide of potassium, etc.. as much cod-liver 
oil as the patient will take. Very little permanent good will be 
done in the treatment of epilepsy, unless cod-liver oil be adminis- 
tered. Where this has been taken regularly and the attacks 
staved of! for a couple of years, hopes may be given to the 
patient that he will not be troubled any more by them. 

4. In Kidney Diseases. — Diabetes mellitus is a disease in 
some way related to the neuroses, for glycosuria will often follow 
severe nervous shocks and strain, epileptic fits, concussion of 
the brain, etc. Opium is not a remedy for this disease, any more 
than stramonium is for asthma. It diminishes for a short time 
the amount of sugar secreted, and so does good so far as it goes, 
but the dose has to be continually increased, and the disease it- 
self is never really touched. Many cases of diabetes mellitus 
have recovered, but in every instance it has been where cod- 
liver oil has been administered; and therefore this remedy, 
which acts simply as a food, not as a specific, should never be 
omitted in the treatment of this disease. It may be also given 
in the chronic stages of Bright's disease where there is anasmia, 
but not if there are any symptoms of gastritis, because the oil 
will then be digested with difficulty. 



60 NOTES ON MATERIA MEDICA. 

5. In Pulmonary Diseases. — Cod-liver oil is frequently 
spoken of, as if it were a cure for phthisis. It is nothing of the 
sort. It has no power over the tubercle bacilli, either to 
diminish their number or to prevent their development; and, 
when given in the treatment of this disease, simply facilitates 
expectoration (a property it possesses in common with other oils) 
and keeps up the nutrition of the patient. But these properties 
render the medicine by far the most important remedy to be 
given in consumption, for, by keeping up the patient's strength 
in a wasting disease, he is better enabled to prolong the battle 
with his dread enemy. Cod-liver oil will prolong the life so much 
in these cases that Dr. Williams, of London, England, than 
whom no greater authority upon this subject has ever lived, has 
stated that whereas forty years ago the average duration of life, 
after the symptoms of the disease had been developed, was only 
twenty-two months, it is now eight years. This statement was 
not based upon results obtained in a few isolated cases. During 
a period of forty years, he kept a record of his cases and the effect 
of treatment. When they had reached the number of twelve 
thousand, he divided them into periods of ten years each, with 
the duration of life in the first, second, third, and fourth decades. 
In the first decade, where no cod-liver oil was used, the average 
duration of life was twenty-two months from the beginning of 
the disease, while in the last decade the duration was prolonged 
eight and a half years. His record of treatment showed that 
this increase in time was mainly due to the use of cod-liver oil. 

Its action in phthisis illustrates the advantages to be obtained 
from the use of cod-liver oil, in all diseases where there is sup- 
puration, as diseases of bone, ulcers, etc., as this valuable food 
supplies the deficiency caused by the discharge of much pus, the 
patient, as a rule, being able to bear the oil very well. 

6. In Skin Diseases. — Cod-liver oil may be beneficially ad- 
ministered in the treatment of skin diseases of a scaly nature, 
such as eczema, etc., where these are not dependent upon 
toxsemia. 

7. In Fevers. — It is extremely difficult to obtain good results 
from the administration of -cod-liver oil in fevers, because, as 
soon as the temperature of the blood is raised, the digestive and 



MEDICINAL REMEDIES. 61 

other secretions are suspended, and so digestion is hindered. 
If, therefore, the temperature rises above 100° F., cod-liver oil 
should not be given. The temperature must be lowered first, 
otherwise the oil will not be digested, and distress is added to 
the very part that should be in the best possible condition in 
this disease. When the temperature is 100° F., it may be given, 
provided the stomach has. other forms of food besides oil in it. 

Administration of Cod-liyer Oil. 
The rule is that it should always be given from one-half to 
three-quarters of an hour after meals, as at that time the 
stomachal digestion is at its height and the food is passing 
into the intestines. Its digestion may be aided and the stomach 
reudered tolerant, by administering just before the oil a little 
vegetable acid, particularly lemon juice. A more common and 
also better combination is bismuth and pepsin, which prevents 
intestinal fermentation. If the patient complains that he tastes 
the oil an hour or two after taking it, it is best to discontinue 
its use, for the resentments of the stomach are incurable. 

Summary oe the Uses of Cod-liyer Oil. 

1. The function of fat in the economy is to produce force, and 
it is therefore demanded by the tissues in direct proportion to 
their activity, which is (1) nervous, (2) growing, (3) muscular, 
(4) glandular, (5) mechanical. 

2. As a nerve food in early childhood, and as a prophylactic 
against ulcerative diseases of the eyes and ears, asthma due to 
weakened mucous membranes, convulsive diseases, and in many 
cases tuberculosis. 

3. Combined with other remedies for the treatment of true 
nervous diseases, such as epilepsy, neuralgia, megrim, etc., not- 
ably so if hereditary. 

4. For chronic rheumatism, essentially a skin disease. 

5. For diabetes mellitus and chronic forms of B right's disease, 
where there is ansemia but no gastritis. 

6. For phthisis, to facilitate cough and sustain strength. 

7. For skin diseases of a scaly nature, not dependent upon 
toxasmia. 



62 XOTES ON MATERIA MEDICA. 

8. For fevers where the temperature is not above 100° F. 

9. For all diseases where there is suppuration. 



II. Iron (Ferrum). 

Iron is an essential element of the red blood-corpuscles and is 
found in variable quantities in the various articles of ordinary 
diet. 

As cod-liver oil is the great food of the nervous system, iron 
is the great respiratory food. It is found normally in the red 
blood-corpuscles exclusively. It has only one function, viz., to 
be the carrier of oxygen, to the tissues. 

" Without iron in the blood we could not breathe." All the 
active tissues and organs consume a certain amount of oxygen 
in the discharge of their functions, but the muscular system is 
especially dependent upon oxygenation for its activity. 

The muscular tissues are the moving apparatus of bodily 
mechanism in all its forms, and therefore carry on breathing. 
But muscular tissues also carry on the circulation; the nervous 
system can regulate the circulation, but without the former the 
latter could not act at all. 

All the circulation, arterial, venous, and lymphatic, is de- 
pendent upon the amount of muscular power supplied by the 
heart, arteries, arterioles, and veins. 

Where it fails and congestion occurs, it is due to the fact of 
the failure of part of the muscular apparatus. 

In the same way the entire alimentary canal is a muscular 
organ. Secretion is not dependent on oxygen, but muscular 
movement is, and without the latter, secretions would come to a 
perfect standstill. 

The great respiratory tract has a prodigious muscular ap- 
paratus, having bronchial tubes which keep up their work inces- 
santly. Many a case of chronic bronchitis, therefore, is better 
treated by iron than by expectorants; the trouble is the inability 
of the muscles, from weakness, to keep the bronchial tract clear. 

Iron is the remedy because all through nature muscular 
power depends upon the activity of breathing. 



MEDICINAL REMEDIES. 63 

Muscular power, therefore, is in direct proportion to the 
efficiency of the respirations. Thus, those persons who live in 
the country and pass most of their time out of doors, other 
things being equal, are much more muscular than those leading 
an indoor and sedentary life. 

Birds, whose respiratory apparatus is remarkably active, are 
far more powerful in proportion to their size than mammals, 
and insects breathing through every pore of their body have a 
muscular power that is marvellous. 

It has been calculated by Prof. Huxley that if a man pos- 
sessed the proportionate muscular power of a flea, he would be 
able to lift such an enormous building as the Newgate Prison 
of London. 

Oxygen is the motor power of the muscles. Of all the mus- 
cular work done by the body, four-fifths is done by the involun- 
tary muscles (owing to their unresting functional work), and 
only one-fifth by the voluntary. Respiration, however, and its 
influence on muscular action, are in direct ratio to the amount 
of oxygen taken in the lungs. 

The difference in muscular development between man and 
woman, in highly civilized communities, is explained on the 
same principle. Therefore a frequent cause of constipation in 
women, is due to the fact that they are almost constantly in the 
sitting posture, when the respiratory activity is one-third less 
than when standing or moving about, resulting in a condition 
of great muscular weakness. 

In races whose mode of life is more primitive, this difference 
between the sexes is far less marked. Parturition in these 
women is easy, and uterine diseases due to muscular weakness 
almost unknown. 

Therefore increase respiration. There is more success in the 
treatment of uterine ailments in this way than by any other 
measures. 

In all disorders due to this cause, the first indication is pure 
air. This having been accomplished, iron should be exhibited 
in order to increase the number of red blood-corpuscles and 
their capacity to take up oxygen, so that the system may be 
benefited by the pure air. 



64 notes on materia medica. 

Uses oe Iron. 

As a Restorative. — Iron is indicated in certain forms of anaemia, 
and contra-indicated in others. Iron should not be given in con- 
ditions of anaemia with fever, nor where the anaemia is due to 
some malignant disease, such as cancer, Addison's disease, etc., 
nor where there is a tendency to haemorrhages. 

But for anaemia without fever, as in chlorosis, it is the specific; 
it is also indicated in forms of anaemia due to starvation, i.e., 
imperfect digestive powers. 

One of the commonest forms occurs in women, from their very 
sedentary habits; they will pass weeks at a time taking in^ 
sufficient meals. In these cases iron should be given; also in all 
forms of blood poisoning that have a tendency to produce dis- 
integration of the blood, such as malaria, where there is a 
tendency to a dissolution of the red blood-corpuscles with libera- 
tion of their haemoglobin; in Bright' 's disease, because the urea 
dissolves the red blood-corpuscles also; and in jaundice, where 
the elements of the bile have the same tendency, causing bleed- 
ing at the gums, and ecchymotic spots on various parts of the 
body, due to the liberation of haemoglobin from the red blood- 
corpuscles. 

The best preparation to give in these cases is the tincture of 
the perchloride, or muriate tincture of iron. 

Apart from its restorative properties, it is a decided diuretic 
from the presence of chloric ether, produced by the action of 
the hydrochloric acid on the alcohol. 

In Bright' s disease, alcohol is contra-indicated, both on ac- 
count of the condition of the kidneys and the gastritis which 
is almost always present, so that the infusions of the vegetable 
bitters should- be used in place of the tinctures. 

If vomiting is present, iron should be given in the form of pills, 
composed of the carbonate, combined with bismuth, the action 
being very beneficial upon the mucous membrane of the stomach. 

Jaundice shows that there is more or less cholaemia, and that 
destruction of the red blood-corpuscles is going on. Iron should 
be given for the same reasons as in Bright's disease, provided 
there is no fever. 



MEDICINAL REMEDIES. 65 

Various forms of neuralgia, and especially those of the inter- 
mittent variety, are associated with, if not dependent upon, an 
anaemic condition due to derangement of the spleen and liver. 
In these cases iron is of decided value. 

la speaking of anaemia as an indication for the use of iron, 
that form characterized by paleness or loss of color is intended, 
and not those forms that are due to deficiency of some other 
constituent of the blood, as fat, phosphorus, etc. 

Chlorosis is a form of starvation which occurs in girls and 
young women, from arrest of menstruation, occasioned generally 
by some shock to the nervous system (in a majority of cases, 
cold) which paralyzes that plexus that presides over the func- 
tions of the organs concerned in menstruation. This condition 
causes reflex paralysis of the muscular fibres and glandular 
structures of the entire alimentary canal, preventing the proper 
digestion and assimilation of food, and giving rise to obstinate 
constipation followed by anaemia of the most profound kind. 

The symptoms of this disease are many and varied. The first 
thing that the patients notice is a shortness of breath on the 
slightest exertion. They become easily tired; the heart beats 
tumultuously on going upstairs or after walking fast. They have 
pain at the nape of the neck and occipital neuralgia, with reflex 
irritation over the eyes; pain in the left side, with shortness of 
breath, with short hacking or loud barking cough; dull, ach- 
ing pain between the shoulder blades. Feet and hands are cold 
on account of the feeble circulation. Appetite variable. Every 
one of these symptoms can be explained by weakness of the mus- 
cular apparatus of the spine. 

This muscular weakness is so great that it is a task for them 
to hold up their heads, or even to sit erect, and this leads to 
curvature of the spine, which is common in these patients. 

In this disease, iron must be administered systematically and 
perseveringly. Unless the bowels are moved, it is quite impos- 
sible for the iron to be assimilated. 

Cathartics that do not weaken the intestines, should therefore 
be given ; small doses of rhubarb, aloes, myrrh, salol, resorcin, 
or the salicylate of sodium, can be given. 

The ovarian irritation must be overcome by the persistent 
5 



66 KOTES OX MATEKIA. MEDICA. 

application of dry heat to the feet. Vegetable bitters and mineral 
acids may also be given to improve the appetite. 

Ammonia, for some reason, assists the stomach in digesting 
iron. 

The following is useful in chlorosis : 

5 Ferri Sulphatis, 3 ss. 

Potassii Carbonatis, 3 ss. 

Bismutlii Carbonatis, ..... gr. xx. 

Extracti Nucis Vomicae, . . . . . gr. xv. 

M. et fiant pilulse No. xxx. 

Sig. One pill after meals. 

After fevers, there is always more or less anaemia; the muscles 
are wasted, brittle, and more or less degenerated, according to 
the length of the fever. The weakness of the muscular system 
is shown in the acceleration of the pulse, due to cardiac weak- 
ness, on the slightest exertion, as setting the patient up in bed. 
The administration of iron hastens and assists the reparative 
process, and should never be neglected, combined with other 
restoratives. 

In diseases of the thoracic viscera : Sudden heart failure in 
some cases produces epilepsy. These patients will after the 
convulsion remain in a prolonged state of syncope; and, differ- 
ing from other forms of epilepsy, the temperature will be low- 
ered (as a rule, epilepsy raises the temperature). In some in- 
stances the temperature may be lowered to 95°, death frequently 
taking place in this state; great flatulency of the stomach is 
also present. 

This disease is caused by fatty degeneration of the heart and 
consequent weakness of its muscular walls. The patient should 
be in the open air as much as possible, combining this treatment 
with iron. Inconjunct'on with this, five drops of the tincture of 
strophanthus and one drop of the one-per-cent solution of nitro- 
glycerin should be given. 

The following is useful in conditions of nervous exhaustion, 
muscular weakness after fevers, dyspepsia, and weak digestive 
powers, with feeble propulsive power of the heart and congestion 
of the liver, the entire portal circulation being embarrassed, pro- 
ducing jaundice, etc. : 



3 lv, 


. 3i. 


3ij- 


aa §iv. 


!iij- 



MEDICINAL REMEDIES. 67 

I£ Ammonii Carbonatis, .... 

Ferri et Ammonii Citratis, 
Tincturae Nucis Vomicae, .... 
Tincturae Quassiae, 1 
Tincturae Gentianae, .... 

Elixir simplicis, 

Aquae Camphorae, q. s. ad Oi. 

M. et sig. One or two tablespoonfuls after meals, in water. 

Heart disease is an accident that occurs very often in early 
life, the result of the circulation of the rheumatic poison in the 
blood. This rheumatic poison in the case of children may give 
rise to chorea and heart disease, or to heart disease alone, with 
but slight or no affections of the joints; later on in life inflam- 
mation of the heart rarely occurs without pronounced inflamma- 
tion of the joints. 

This inflammation causes valvular obstruction, a mere mechan- 
ical result. Formerly it was thought that this valvular obstruc- 
tion was the chief cause of heart disease. It is now known that 
it is not the chief, or even the common, cause of heart failure. 
Instead of that, heart disease is far more frequent as the result 
of weakness of the circulation. The muscular structure of the 
arteries is weakened, the circulation becomes clogged, and the 
heart has not sufficient power to overcome the obstruction. 
Now, this is caused by deficient oxygenation; the patient breathes 
too little, the arterial muscles begin to fail, and a quantity of 
blood is thrown back into the heart; the heart grows larger, 
but not with good muscle, and sooner or later it begins to dilate. 

It should be remembered that the great danger in diseases of 
this kind is from muscular weakness, and the only remedy for 
this is oxygen; therefore iron is always indicated in heart dis- 
ease, for which it is the true remedy. 

It should be taken ten times in each year, for one or two 
weeks at a time, and the patient should be in the open air as 
much as possible. 

On the same principle this should be the treatment in chronic 

1 In giving vegetable bitters with iron, we are limited to those that do not 
contain tannin; otherwise ink is formed. 



68 NOTES ON MATERIA MEDICA. 

bronchitis, a disease combined with cough, and therefore some- 
times mistaken for consumption. 

The characteristics of the two diseases should be recognized 
immediately, for in phthisis iron should not be given; in bron- 
chitis, iron always. These are two diseases not of the same 
character or nature, and do not produce the same results. 
Phthisis is a febrile disease; it is also a wasting disease; there- 
fore from the first there is a tendency to shrinkage of bulk 
of the body, and notably of the lungs. The bones are small, 
especially the clavicle and the ribs. The neck is elongated, the 
chin being carried forward. The skin of the face is retracted, 
owing to the platysma myoides being put on the stretch, and 
hence the drawn expression of phthisis. 

Bronchitis is exactly the opposite. It is not a febrile com- 
plaint, the temperature being normal. On account of the work 
performed, all the muscles of respiration become large, and the 
neck becomes very short and thick; the shoulders are elevated. 
Instead of the chest being flattened and contracted as in 
phthisis, it is barrel-shaped. 

In bronchitis the great danger is in dilatation of the air vesi- 
cles, and paralysis of the muscular structure of the bronchial 
tubes. 

The patient can be saved from emphysema, from dilatation of 
the bronchial tubes, from cough and consecutive weakness of 
the right side of the heart, by preventing muscular degenera- 
tion; hence iron should be given in bronchitis of aged persons, 
because of weak heart and weak lung together. 

Genito-urinary tract : Uterine diseases, characterized by 
weakness of the uterus or its appendages, as prolapsus uteri, 
etc.; the chronic constipation of women; weakness of the blad- 
der, dependent either on the degeneration of the muscular 
walls of the bladder or due to sluggish portal circulation; also 
enlargement of the prostate gland in the male. 

In diabetes, iron should be given; constipation should be care- 
fully guarded against in this disease, as it would be a fatal com- 
plication. The iron should be combined with a laxative 

Nervous exhaustion, accompanied by the accumulation of 
phosphates and haematin in the urine, indicates a great waste 



MEDICINAL REMEDIES. 69 

of the red blood-corpuscles, and calls for the use of iron, together 
with the other blood and nerve restoratives, especially cod-liver 
oil and phosphorus. 

As a Symptom or Functional Medicine. — Under certain con- 
ditions, iron acts as a symptom medicine, where its efficacy de- 
pends on its being an antiseptic and a cardiac stimulant. 

Everything that increases oxygenation is an antiseptic. 

When a disease has a tendency to ulceration and the produc- 
tion of pus, antiseptics are called for, and iron is an important 
one. In erysipelas, it should be given in full doses, i.e., as 
much as the stomach will bear. From one-half to one drachm 
of the muriate tincture can be given every two hours; it should 
be well diluted with water, and taken through a glass tube to 
prevent discoloration of the teeth. In severe cases of acute 
erysipelas, it may be necessary to give twenty drops every hour. 

In pneumonia, when the temperature is low, with debilitated 
heart, occurring in alcoholic subjects, the muriate tincture of 
iron and digitalis do well. 

It can also be given in diphtheria in a like manner. 

In phagedenic ulcers and chancroids with a tendency to rapid 
sloughing, twenty grains of the potassio-tartrate every one, two, 
or three hours will often arrest the destructive process. 

In chronic and indolent ulcers : Various ulcers occurring 
upon the leg are best treated by a wash containiug five grains of 
the sulphate to an ounce of water ; if the ulcers are very sen- 
sitive and painful, the strength of the solution should be re- 
duced. 

The salts of iron are as follows: The proto, ferrous, or non- 
astringent salts ; the per, ferric, or astringent salts. The proto 
salts are combined with a vegetable acid, and for the most part 
are greenish in color. They are, in moderate doses, not at all 
disturbing to the stomach. They are, however, very unstable, 
being very readily converted into the per salts by absorbing oxy- 
gen from the air, unless protected by some such substance as 
sugar or honey. 

One of the best of this class is the saccharated carbonate, or 
Vallet's mass. This is readily tolerated by weak stomachs, and 
the sugar prevents the air from turning it into iron rust. This is 



70 notes ox materia medica. 

one of the best preparations to give in pill form. Quinine and 
nux vomica can also be combined with it. 

The dose of the saccharated carbonate is from three to five 
grains; similar to this is the saccharated iodide of iron in liquid 
and pill form. The liquid form is the s} T rup of the iodide of iron; 
the pill form was formerly known as Blancard's pills, but is now 
an officinal preparation. Another form is the proto-carbonate, 
made extemporaneously by combining the sulphate of iron with 
the carbonate of potassium; it has already been referred to in 
the treatment of chlorosis. 

The double salts of iron with any of the alkaloids form very 
uncertain preparations. There are the salts of iron and quinine, 
and the salts of iron and strychnine, and a triple salt of iron, 
quinine, and strychnine. They form scale preparations that afford 
the combinations sought for, but there is this difficulty; iron, 
being the strongest base, uses up the acid and leaves but very 
little for quinine and strychnine, consequently the element of 
quantity is uncertain. 

The vegetable salts of iron are made much more soluble and 
pleasant to the taste by combining them with ammonia, and 
hence the citrate of iron is generally prescribed as the ammonia 
citrate. This is a soluble salt, two bases combining with one 
acid. This cannot be made in pill form, but should be given in 
solution, and is preferable to many others on account of the 
absence of a strong iron taste (dose, 1 to 5 grains). 

Another of the vegetable salts of iron that is well borne by 
the stomach is the potassio-tartrate (dose, 5 to 10 grains). 

The Astringent Class. — The per salts are the combination 
of iron with a mineral acid, and their astringency depends upon 
this fact. 

These salts are for the most part yellow or reddish brown in 
color, and are more or less irritating to the stomach. 

The sulphate of iron is quite astringent, with a marked metal- 
lic taste; it is one of the best preparations to give to anaemic pa- 
tients with weak digestion. 

Given with myrrh and aloes, it is an old prescription in the 
treatment of amenorrhea (dose, one-half to one grain, three 
times a day). Curious in one respect — although astringent in 



MEDICINAL REMEDIES. 71 

small doses, it is a laxative in those cases of constipation due to 
relaxed muscular power of the walls of the stomach. It is often 
given as an addition to laxative pills. 

The astringent form most frequently prescribed is the tinctura 
ferri chlor.di, or the muriated tincture of iron, and is prepared 
by adding alcohol to the officinal liquor ferri chloridi, and con- 
tains the sesquichloride of iron, muriatic acid, and alcohol. 
From the reaction of the alcohol and acid, chloric ether is pro- 
duced. 

This preparation has a variety of actions: (a) it is a restora- 
tive, because of the iron; (b) it is an astringent, on account of 
hydrochloric acid and the iron; (c) an antispasmodic, from the 
presence of the ether; (d) a diuretic, from the same cause; 
(e) an antiseptic, because of the chlorine and the iron; (/) it is an 
expectorant and a diaphoretic, because all ethers are more or 
less so. 

The muriate tincture can be given in spasms of the urethra, 
the ureter, or the bladder (dose, ten to fifteen drops every hour). 

Iron is indicated where the urea is producing the anaemia 
characteristic of Bright's disease, and can be combined with the 
sweet spirits of nitre and the bichloride of mercury, as in the 
following: 

R Hydrargyri Corrosivi Chloridi, . 

Tincturae Ferri Chloridi, . . ■ . 

Tincturae Nucis Vomicae, .... 
Spiritus iEtheris Mtrosi, .... 

Elixir simplicis, 

Aquae, . . q. 

M. Sig. Two teaspoonfuls in water three times per day. 

In some cases the dose of the sweet spirits of nitre may be too 
strong; if so, one-half of the quantity should be prescribed. 
After one bottle has been used, the corrosive sublimate may be 
left out and then resumed after another has been taken. 

Administration" of Iron. 

1. Iron should never be given when fever is present, as it in- 
creases the feb;ile condition and is undigested because of the 
small quantity of the digestive fluids. Hence great care must 



gr.i. 


. 3ij- 


3 ij- 


• liij- 


5«. 


ad I vi. 



72 NOTES ON materia medica. 

be taken in giving it to phthisical patients. It should be 
stopped at once on the occurrence of any febrile symptoms. 

2. The dose must be in proportion to the patient's appetite. 
"When the appetite is small, the vegetable bitters (those free 
from tannin, i.e., quassia, gentian, and calumba) should be 
given to increase it. Carbonic acid and ammonia assist the 
digestion of iron. 

3. Iron should be invariably given on a full stomach. 

4. Constipation should be guarded against, and cathartics 
given when necessary, the best for this purpose being rhubarb 
and aloes. 

5. Whenever possible, and especially when iron is adminis- 
tered in pill form, the proto-sulphate, with the carbonate of 
potash, should be preferred, both on account of its cheapness 
and the ease with which it is assimilated. 

6. The stronger preparations of iron, such as the tincture of 
the chloride, should always be freely diluted with water, tc 
avoid injuring the teeth and irritating the stomach. 

A slight discoloration may occur from the use of any of the 
preparations of iron, but it is never permanent or injurious. 

Summary of the Uses of Iron. 

Iron is indicated in all anosmias, unless they are accompanied 
by fever or due to some malignant disease. In chlorosis, the. 
carbonate, made extemporaneously by combining the sulphate 
of iron with the carbonate of potassium, should be used. 

After fevers there is always more or less ansemia. 

The weakness of the muscular system is shown by the accele- 
ration of the pulse, due to cardiac weakness on the slightest ex-- 
ertion, as setting the patient up in bed. 

Iron combined with restoratives should always be given. 

In Bright 's disease, the muriate tincture, combined with cor-, 
rosive sublimate and the sweet spirits of nitre, can be given. 

In diabetes, iron should be given; constipation should be carev 
fully guarded against. 

The iron should be given with a laxative. 

Nervous exhaustion, accompanied by the accumulation of 
phosphates and haematin in the urine, calls for iron. 



MEDIC US AL REMEDIES. 73 

In chronic constipation of women ; uterine disease, charac- 
terized by weakness of the uterus or its attachments, prolapsus 
uteri, etc. ; weakness of the Madder. Also in enlargement of the 
prostate gland in the male. 

In cardiac disease, the patient should be in the open air as 
much as possible, combining this treatment with iron. 

All diseases of the heart call for the administration of iron. 
By increasing the muscular strength of the heart, it acts as 
a prophylactic to dilatation. For the same reason it should be 
given in bronchitis and emphysema. 

In pneumonia, when the temperature is low, with a debilitated 
heart, occurring in alcoholic subjects, the muriate tincture 
should be given with digitalis. 

It can also be given in diphtheria with good results. 

In these cases large doses should be given, the muriate tinc- 
ture acting as a symptom medicine. 

In phagedenic ulcers and chancroids with a tendency to rapid 
sloughing, 20 grains of the potassio-tartrate every one, two, or 
three hours can be given. 

In chronic and indolent ulcers: Varicose ulcers can be treated 
by a wash containing 5 grains of the sulphate to an ounce of 
water. 

Various forms of neuralgias, and especially those of the inter- 
mittent type and associated with anaemia, are best treated with 
iron. 

III. Phosphorus. 

Phosphorus is a constituent of the most important tissues of 
the body, especially of the brain and nerve tissue. On theoret- 
ical grounds, therefore, it has been deemed by many practitioners 
to be a brain food, but practically this has not been proven. It 
certainly is not to be compared in its action as a restorative 
to either cod-liver oil or iron, even when given in the form of 
hypophosphites, etc. It is physiologically instructive to note 
that phosphorus, unlike iron, always comes to us mixed with 
vegetable or animal tissues, and before it becomes a pari of the 
system it must go through many complicated processes. Tfee 
expectation, therefore, that phosphorus, given by itself, will act 



74 NOTES ON MATERIA MEDICA. 

as a nerve nutrient does not seem to be warranted. Dissolved 
in oil or made into a pill, phosphorus, in a mineral form, has 
the following uses: It stimulates the circulation, increasing the 
strength and frequency of the pulse, and hence may be given as 
a cardiac stimulant, especially where lengthened stimulation is 
required, as its effects last much longer than those of alcohol or 
ammonia, continuing for several days after its administration 
has been discontinued. It is very beneficial, therefore, in ner- 
vous exhaustion or neurasthenia, characterized by a very soft 
and compressible pulse, whether slow or fast, with cold extrem- 
ities, to stimulate the circulation. When the soft, compressible 
pulse is noticed in epilepsy, it is an indication for the use of 
phosphorus. It is also beneficial in some cases of chronic men- 
ingitis without excitement, and in progressive paralysis of the 
insane. 

Phosphorus sometimes relieves very markedly certain neural- 
gias, notably of the trigeminus — that form of headache begin- 
ning with disturbance of vision {diplopia), or even total blind- 
ness for a few hours, attended by pain, and usually on one side 
only, and which is a true nervous disease. The patients are 
prostrated by the pain, the attack usually passing off with 
intense nausea and vomiting. The treatment of this affection 
consists in trying to prevent or mitigate the attack by giving 
the fluid extract of ergot in drachm doses, and repeating once if 
necessary. To treat the disease itself, phosphorus should be 
exhibited perseveringly for a month or six weeks, then rotating 
it every week or ten days with one-thirtieth of a grain of bi- 
chloride of mercury combined with one-twentieth of a grain of 
arsenite of soda. Often, however, immediate relief follows after 
one or two doses of phosphorus have been taken, thus showing 
that in these cases it does not act as a restorative, but as a 
neurotic. 

Tic douloureux, when not due to the pressure of a tumor or 
organic intercranial disease, should be treated with phosphorus. 
It often gives very great relief, and, when it does so, the prog- 
nosis is good. 

The syrup of hypophosphite of sodium is a very good remedy 
for nervous symptoms dependent on cardiac exhaustion. Thus, 



MEDICINAL KEMEDIES. 75 

ossification of the aorta is the not infrequent cause, in old people, 
of hallucinations, the blood supply to the brain being irregular 
from weakness of the heart and aortic regurgitation. In 
younger people, cardiac exhaustion will cause failure of memory 
and will power, difficulty in concentrating the mind, depression 
of spirits, and irregular pulse. The hypophosphite may also be 
given in all forms of passive lueak delirium. It does not do 
much good in phthisis, but may be given temporarily where the 
patient becomes nauseated with cod-liver oil. The syrup should 
always be acidulated with dilute phosphoric acid, for it is very 
sweet, and not easily borne by a weak stomach. Gastric irrita- 
tion should always be avoided in nervous disorders. (Acid 
Phosph. dil., 5 iss. ; Syr. Hypophosphitum, 3 ivss. ; dose, 3 ij. in 
water after meals.) 

Chronic skin diseases of the squamous variety, where there 
are no red patches, only scaly, are benefited by phosphorus in 
combination with cod-liver oil. 

In diabetes mellitus, the only treatment from which any per- 
manent improvement can be expected is that by phosphorus 
combined with cod-liver oil and iron. It should be continued 
systematically even after all traces of sugar have disappeared 
from the urine. 

Contra-indi cations to the use of phosphorus are haemorrhage 
or hemorrhagic diathesis, jaundice or liepatic diseases. Both 
these diseases are produced by phosphorus-poisoning. It is 
beneficial in diseases of the spleen. 

Toxicology. — If given in excess, phosphorus acts as a caustic 
on the mucous membranes of the alimentary tract. In small 
doses it produces fatty degeneration of the liver, characterized 
by continued jaundice, and simulating acute yelloiu atrophy of 
the liver. The fumes of phosphorus attack the bony structures, 
when unprotected by the periosteum, producing necrosis. In 
artisans working in the fumes of phosphorus, it attacks the jaw- 
bone only when the teeth are decayed. There is no direct anti- 
dote, but oil of turpentine is claimed to act as a prophylactic. 
Magnesia in suspension and sulphate of copper should be used 
in case of poisoning. 

Preparations and Administrations. — The elementary form 



76 KOTES ON MATERIA MEDICA. 

is the best, and used in all diseases except phthisis and 
shin diseases. The dose is T \^ to t ^q of a grain in pill form, or 
as phosphorized oil (gr. iij., Olive Oil 5 i.; dose, gtt. 5 to 10). 

Tinctura phosphori is phosphorus dissolved in glycerin and 
water, and flavored with peppermint. It has not the dis- 
agreeable taste of the solution in oil, and does not regurgitate. 
The close is one drachm in a little water or wine. 

Phosphorus dissolved in chloroform, ether, and sulphide of 
carbon is also used. 

Compound phosphorus pill contains phosphorus, strychnine, 
quinine, or iron. The hypophosphites part with their phosphorus 
in the body and thus give the effects of phosphorus itself (dose, 
Hypophosphites, gr.viii.-xv. ; Syrup of Hypophosphites, 3 i. — ii. ). 



IT. Quinine. 

Quinine is an alkaloid obtained from the bark of the cinchona 
tree. This tree received its name from the wife of a Spanish 
consul at Peru, the Countess of Cinchon, who, having been cured 
of a malarial fever by usiug its bark, iatroducedit into Europe. 
The officinal varieties of cinchona are the barks of the Cinchona 
flava and Cinchona rubra. The barks which are richest in 
quinine and allied alkaloids are obtained from trees growing 
on the Andes, where the rainfall is excessive and the atmosphere 
charged with vapor. The red and the pale barks of Peru, al- 
though rich in the alkaloids, are inferior to the yellow bark of 
Bolivia. Of late years, large amounts are shipped from India 
and the island of Java. 

Quinine is a restorative, being a food, because it is analogous 
to one of the normal constituents of the system, viz., taurin; 
a deficiency of this is always accompanied by more or less dis- 
turbance of health, which yields to the use of quinine. Taurin 
is a nitrogenized crystalline body secreted by the liver, and found 
in the bile together with cholic acid and sodium, forming the 
taurocholate of sodium. About one ounce of taurin is daily poured 
into the intestines and reabsorbed into the circulation, where its 
office seems to be that of a germicide or natural antiseptic to 



MEDICINAL REMEDIES. 77 

prevent and arrest the development and multiplication of bac- 
teria and other microscopic germs which find their way into the 
system. 

A consideration of the physiological properties of quinine 
shows a great similarity between it and taurin; again, the 
majority of cases in which quinine is indicated depend upon 
some derangement of the functions of the liver. 

Therapeutic Uses of Quinine. 

As an Antiperiodic. — All forms of malarial fevers are bene- 
fited by quinine, as well as many diseases and disorders of mala- 
rial origin. It has now been demonstrated that malaria de- 
pends on an infection of the system by a low organism which 
enters the red blood-2orpuscles and destroys them. Marked 
periodicity is a special and distinctive characteristic of malarial 
disorders, and where this is absent the term malarial should 
never b3 applied to any disease. The periodic symptoms of 
malaria may be extremely varied. Often it will be high fever, 
but it may be just the opposite — a subnormal temperature not 
followed by fever; the disease may appear only at a certain 
time, with first chills, then high temperature, fever, and sweat- 
ing; or it may appear at a certain time with sweating as the 
only symptom. This period of time also varies considerably. 
The attacks may occur every hour, every day, every two days, 
three days, once a week, etc In some cases the symptoms may 
be purely nervous, as brow ague, intercostal neuralgia; in other 
cases there may be abdominal pain with disturbance of motion; 
in others, opisthotonos, and very commonly, in children, cough- 
ing is the only manifestation of the disease. (In endeavoring 
to discover from the patient if there has been periodicity in the 
symptoms, do not ask if he has had a fever or headache at such 
and such a time, as he will be very apt to reply that it has been 
continuous, but ask if he does not feel better at certain times. 
An answer to this question in the affirmative indicates periodi- 
city just as well as by the former method.) The following in- 
stance illustrates the masked form which malaria often assumes, 
and at the same time the periodicity of the disease: A man 



78 KOTES (W MATERIA MEDICA. 

was sent to Eoosevelt Hospital in a state of coma, apparently 
uraamic, with diagnosis of acute nephritis. Temperature, 104° 
F. Considerable quantity of albumin and blood in the urine. 
The patient, however, would come out of the comatose condi- 
tion in the forenoon and return to it in the afternoon. The 
blood was examined under the microscope, and evidences of 
malarial infection were found. The administration of quinine 
twice daily in twenty-grain doses was followed by complete re- 
covery in a month from date of admission. A large proportion 
of the cases of chronic Bright 's disease have begun as malarial 
congestions and inflammations, and quinine, if given early 
and in sufficient quantity, would often have prevented the dis- 
ease. In the fevers of children, if blood is present in the urine, 
it shows malaria to be present, and is an indication for the ex- 
hibition of quinine. 

This periodicity is especially characteristic of the malarial fe- 
vers, the intermittent and remittent. An intermittent fever is 
a fever in which the febrile exacerbations occur in regular suc- 
cession, and between the exacerbations there is complete ab- 
sence of fever, the temperature being normal or even subnor- 
mal. Gradually the periods of cessation of fever get shorter 
and shorter, until finally the fever becomes remittent. A re- 
mittent fever is continuous throughout the twenty-four hours, 
but at certain times there are marked remissions in its severity. 
It does not altogether abate, for if it did the fever would be 
intermittent. The particular time in the day at which the 
fever diminishes is called the period of remission, and corre- 
sponds to the time when, in the intermittent stage, the fever 
was completely in abeyance. The majority of fevers have more 
or less remission, especially at the beginning of their course, 
but it is not periodic, as in the malarial fevers, and occurs at the 
period of greatest vitality, viz., between 8 and 10 a.m. Quite 
a number of other affections besides ague have chills and fever, 
but unless there is decided periodicity they are non-malarial. 
Thus the discharge of pus or the passage of gall stones will oc- 
casion chills followed by fever and sweating. In pernicious 
anaemia and in malignant disease, there will also be chills and 
fever. Quinine must not, therefore, be given indiscriminately 



MEDICINAL KEMEDIES. 19 

whenever there are chills and fever, for, unless malarial, the dis- 
order will often be aggravated by its use. If quinine is not 
needed, it acts as a local irritant to tender stomachs, and in 
fevers there is always more or less tenderness of the stomach. 

The dose of quinine to be given in malarial fever depends on 
the virulence of the infection, which generally varies with the 
locality. Some malarial affections are very severe; for example, 
in that form of malaria called malignant congestive chill, the 
worst examples of which occur in Africa and on the shores of 
the Dead Sea, there is a sudden depression of the heart's ac- 
tion; the patient pants for breath, the voice is lost, and the 
gums have a dreadful appearance; there are cramps in the 
calves of the legs, and a burning sensation in the pit of the 
stomach; the skin shrinks, and the face assumes the Hippo- 
cratic aspect. Generally the second chill in this disease is fatal. 
The mode of treatment successfully adopted in one of these 
cases, was the immediate administration of thirty grains of qui- 
nine, followed, after an hour's interval, by thirty more, and 
after another hour by thirty more. It was not till the last dose 
had been taken that the patient showed any signs of having 
taken quinine. The principle of the treatment was to follow 
up the deficiency in the system that called for quinine. 

In mild cases, ten grains are sufficient. In New York and 
vicinity, twenty grains are required; farther South, as in some 
parts of North Carolina, forty to fifty grains; while in the 
tropics less than sixty grains will not produce any effect in 
severe cases. The quinine appears to be used up in the system 
while it is counteracting the malarial agent, so that no trace of 
the drug is found in the secretions, nor does it produce any 
symptoms of its own while it is acting on the disease. Two 
or three grains will produce cinchonism in the healthy, while 
twenty to sixty, or, as already mentioned, even ninety grains 
will not produce these symptoms where there is malaria. The 
symptoms of cinchonism vary in different people. In some 
cases there is disturbance of audition, sound always seeming to 
come from a distance; other patients have muscular tremors; 
a less frequent symptom is palpitation of the heart, and occa- 
sionally patients have frontal headache. The most general 



80 NOTES ON MATERIA MEDIC A. 

symptom, however, is tinnitus aurium, and this, when pro- 
duced, shows that the maximum dose has been reached, and, if 
pushed further, that the remedial effects of quinine will be lost. 
The next point to be considered is the manner of administering 
quinine for the purpose of breaking up an attack of ague. In 
the first place, no patient recovers from this disease under twenty- 
eight days, no matter how well he may appear. A large dose of 
quinine may cause the disappearance of the recurring chills and 
fever during that period, but the disease is not cured; for at the 
time when these symptoms would otherwise have appeared — 
daily if quotidian, etc. — there will be a sudden increase in the 
amount of urea, phosphates, etc. , excreted in the urine. On 
the seventh day there will be an increase nearly double that of 
the intermediate days, and again on the fourteenth and twenty- 
first days. The continued presence of the germs prevents the 
disease from disappearing, and the growth and fructification of 
several generations occasion the relapses. The germs may re- 
main in the system five or six months without developing suffi- 
ciently to produce any symptoms of disease. In this city, malarial 
troubles are most common in the months of April and Septem- 
ber. In spring, the outbreak of malaria is due to the rejuvenes- 
cence and multiplication of minute forms of vegetable life in 
water, which afford a soil for the development of the malarial 
organism; and if a patient has an attack in April, the probabili- 
ties are that he will have another in the fall, and again on the 
anniversary of the first attack. Whatever lowers the vitality of 
the system, such as loss of sleep, severe changes of weather, etc., 
will, in those who are subject to malaria, cause a recurrence of 
the disease. If the chills and fever remain unbroken for months, 
the patient loses vaso-motor control over the circulation of the 
liver and spleen, 1 and very slight causes, such as an ordinary 
wetting in a summer shower, will cause an enlargement of these 
organs and consequent interference with their functions. The 
administration of quinine should therefore be preceded by a ca- 
thartic — calomel or blue pill — to free the portal circulation, which 
if congested would hinder absorption, as quinine, morphine, and 

1 See article on Cold, p. 276. 



MEDICINAL REMEDIES. 81 

all the vegetable alkaloids, if they remain for much length of 
time in the alimentary canal and are subjected to the action of 
the ordinary digestive fluids there, become so changed as to lose 
largely their special properties. The congestion must be re- 
moved by brisk catharsis, produced either by a couple of com- 
pound cathartic pills, or ten grains each of calomel and jalap 
with a few grains of bicarbonate of soda to prevent griping, or, 
what is better still, by the following : 

3 Pil. Hydrargyri, . . . gr. iv. 

Sodii Bicarb., . . . . gr. x. 

Ex. Colocynth. Co., . . . . . gr. vi. 

M. et div. in capsul. No. iii. Sig. One at night. 

The quinine is to be given with the first movement of the 
bowels. Three or four days afterwards a cathartic should again 
be given, as there is a constant tendency to splenic and hepatic 
congestion. 

There is constant failure in the treatment of malarial poison- 
ing by the use of quinine, and it nearly always arises from the 
manner in which the remedy is administered. The point to be 
obtained is the quick absorption of the quinine. Suppose, for 
example, you are called upon to prescribe in a case of malarial 
poisoning in which there is almost continuous vomiting, as in 
bilious fecer. If there is gastritis present, there will be tender- 
ness upon pressure at the pit of the stomach and in the region 
of the gall bladder; there is apt to be some swelling of the epi- 
gastrium, and the patient vomits as soon as anything is taken. 
It is useless to administer quinine by the mouth under such cir- 
cumstances, because the excessive irritation which it produces 
upon an inflamed mucous membrane causes its rejection at once. 
If injected into the rectum under the same circumstances, it 
will not succeed any better, because rectal absorption is dimin- 
ished on account of portal obstruction. 

Now, if two or three leeches are applied at the epigastrium, 
the vomiting will be arrested almost certainly, and the quinine 
will be absorbed. Do not use either mustard or blisters here to 
arrest the vomiting, for they are vascular stimulants. Topical 
blood-letting, on the other hand, is a prompt vascular sedative. 



82 NOTES ON MATERIA MEDICA. 

The next point is that in malaria quinine should never be 
given alone, but combined with spices which render its absorp- 
tion more rapid and its effects more lasting. Capsicum com- 
bined with quinine will diminish the size of the dose requisite, 
and the same may be said of ginger and other aromatics. A 
good dose of capsicum combined with twenty grains of quinine 
will act as well as thirty grains of quinine without the capsicum. 
Spices in general stimulate the portal circulation and promote 
the flow of bile, and hence their universal use in hot climates. 
There is a tendency on the part of quinine and capsicum to 
purge, and sometimes to purge violently. In such cases, the pur- 
gative action is caused by the increased flow of bile produced by 
the capsicum. Ginger and quinine, when combined, do not 
purge, and make a very good combination. If the medicine 
is administered in form of pills, capsicum may be preferable, 
because of the less bulk required; but, if desirable, the ginger 
may be given separately, and with the same effect as w r hen com- 
bined with the quinine. The proportions should be one grain 
of capsicum to three of quinine; with ginger, one grain of each. 
Quinine may also be given in combination with nutmeg in the 
same proportion as with capsicum. 

Ginger in large doses will sometimes be very effective, and 
may be given in cases of malaria where quinine fails to act. In ob- 
stinate cases, all three — ginger, nutmeg, and capsicum— in what 
is called <( compound nutmeg capsule/' should be used. A nos- 
trum called Warburg's Tincture is very extensively used in this 
country and in India for malaria. As originally made it con- 
tained no less than seventy-six spices, and six grains of quinine 
are more effective, given in combination with this mixture, than 
thirty or forty given alone. The reason is that the spices stimu- 
late the portal circulation, and have also an antiperiodic action, 
as they belong to the carbolic-acid series. These ingredients 
are now prepared in the form of capsules. As aloes is one of 
the drugs used, if six or eight of the capsules are given during 
the day severe diarrhoea may be caused. This, however, may 
be avoided by ordering the administration of capsules which do 
not contain aloes. 

The subsequent treatment of ague is to follow up the dose 



MEDICINAL REMEDIES. 83 

which breaks the attack with one-half that quantity daily, till 
the seventh day after the last chill, when the full dose should 
be given. (If there is any uncertainty as to which is the 
seventh day, the full dose may be given for two days in succes- 
sion.) Continue the treatment with one-third of the original 
dose till the end of the fourth week, giving the full dose on 
every seventh day. The patient, if he has not had the disease 
before, will in all probability now be out of danger, and quinine 
may be given simply as a prophylactic. The dose for this pur- 
pose is one-tenth of that which had been required to break the 
chills, though six grains may safely be given. 

As an Antiseptic and Disinfectant. — Quinine chemically is 
very similar to the carbolic-acid series of disinfectants, and espe- 
cially salicylic acid. A solution of one grain of quinine to 
twelve ounces of water will destroy the movements of bacteria in 
putrescent urine. Depending on this principle is the use of the 
injection of two-thirds of a grain of quinine to an ounce of 
water in chronic cystitis, 1 to prevent the decomposition of 
mucus and sometimes of pus. For this reason quinine should 
always be given in those cases where blood poisoning, or septicae- 
mia, results from the absorption of septic material from deep- 
seated abscesses ; where the infection is taking place from the 
surface of an open wound, a solution of carbolic acid or other 
disinfectant should be used locally with the internal use of 
quinine. 

As an Antiphlogistic and Antisuppurative. — Quinine de- 
stroys the vitality of the white blood-corpuscles, producing in 
them a condition similar to that found in "rigor mortis/' 
Some suppose that quinine prevents the nutrition of the leuco- 
cytes, and thus checks inflammation and suppuration. Whether 
this is so or not, it has been clinically demonstrated that it is 
always indicated in cases of prolonged suppuration, as psoas 
abscess, pneumonic phthisis, -fistulous discharges, etc. Under 
these conditions there is an increased tolerance of the drug; 
large doses (twenty grains) failing to give rise to the symptoms 
of cinchonism. "When symptoms of cinchonism occur, the use 

1 For other disinfectant remedies for this disease, see p. 36. ( 



84 NOTES OX MATERIA MEDIC A. 

of quinine should not be pushed any further, as nothing will 
be gained. 

As a Restorative or Febrile Food. — In fever, the function of 
the liver, together with that of all the glands, is impaired, and 
the composition of the blood more or less altered. Hence on 
recovery from a fever the patient is always more or less jaun- 
diced. In all febrile diseases, quinine is the restorative and 
should be administered, both during and after the fever, in 
restorative doses of from four to six grains a day. 

Where malaria has become chronic, organic changes will often 
take place, the liver and spleen will be enlarged, the blood will 
be very impoverished, and quinine may fail to do any good. 
Not infrequently in these cases the old-fashioned remedy of 
infusion of cinchona bark will be very effective, for it contains 
all the alkaloids, and a very pleasant combination of tannin called 
quinic acid, which has the property of allaying nausea, and 
tannin in small doses, is a valuable medicine for weakness of the 
muscular coats of the stomach and intestines. In chronic dis- 
eases of the bladder, advantage will often be gained by giving 
this infusion; the appetite will be increased, the blood improved, 
and its effects against malaria are shown by the gradual decline 
of the disease. 

' As a Neurotic. — In common with the other members of the 
carbolic-acid series, quinine possesses anaesthetic properties. It 
may be given to relieve pain that is neuralgic, not inflammatory. 
The distinction between these two kinds of pain is very impor- 
tant and very practical. An inflammatory pain is caused by the 
pressure or stretching of the nerves by the inflammatory exuda- 
tion, and has the following characteristics: It cannot bear pres- 
sure, and consequently the patient avoids movements likely to 
exert pressure upon the seat of pain; it is local, and the pain is 
throbbing from the pulsation of the arteries against the nerves- 
Opium is the neurotic for inflammatory paki. Neuralgic pains 
have none of these characteristics; as a rule, they are not 
strictly local, but, on the contrary, have a tendency to radiate, 
and they are relieved by pressure and consequently by move- 
ments. Quinine, antipyrine, and antifebrin are the neurotics for 
neuralgic pains. Quinine is sometimes extremely successful in 



IIUPICIXAL REMEDIES. 85 

neuralgic pains which are periodical and which may be the 
only manifestations of malarial infection, e.g., trow ague and 
malarial headache. In the latter complaint, the face will be 
marked by yellowish streaks running from opposite angles of 
the eyes, and similar lines run toward the mouth in a manner 
peculiar to malarial jaundice. The headache may continue 
from ten to fourteen days, or even longer; it does not, however, 
usually last longer than two weeks. 

As a rule, malarial headache either remits or intermits. It 
always sets in suddenly. It often commences at a certain hour 
of a certain day, and at the same hour of the following days it 
is more severe than at any other time within the twenty-four 
hours. A true malarial headache is as violent at its commence- 
ment as at any time during its course. In a large proportion of 
cases, there will be times when the patient has either decided 
chills or chilly sensations. There may be nothing more than 
the hands getting cold previous to the occurrence of the head- 
ache. It is usually frontal, and sometimes felt on one side only. 

Of course, as a neurotic, quinine in these cases must be given 
as a symptom medicine, not as a disease medicine, and therefore 
should be given in a single large dose. The dose should be 
twenty grains. If the stomach is in an unsettled condition, the 
dose may be divided into two, the second to be taken half an 
hour after the first. As ergot greatly promotes the action of 
quinine as a neurotic, one drachm of the fluid extract, or from 
twenty to thirty grains of the powder, or fifteen to twenty 
grains of the solid extract (Squibb's), may be given with the 
twenty grains of quinine. 1 

As an Antipyretic. — To a certain extent quinine is a symp- 
tom medicine. When taken in a certain way, it has the power 
of reducing the temperature of the body 1° to 3° F. by a dose of 
twenty grains. This power it has in common with all the car- 
bolic-acid series. Certain investigators claim that the anti- 
pyretic action is dependent on arrest or diminution of oxidation 
and tissue metamorphosis. Its use and that of all other medici- 
nal antipyretics is contra-indicated in all prolonged fevers and 

See also Ergot, page 200. 



86 NOTES ON MATERIA MEDICA. 

wherever there is cardiac weakness, for, though lowering the 
temperature, they also weaken the heart's action. 

The four principal alkaloids of Peruvian bark are quinine, 
cinchonine, quinidine, and cinchonidine. 

Quinine is the best and has the greatest antiperiodic power. 
Cinchonine is largely used in the adulteration of quinine; its 
action is very similar, only weaker — twenty grains of cinchonine 
are about equal to fifteen grains of quinine. Cinchonidine in 
combination is quite as active as quinine and as expensive. 
The four alkaloids have been combined under the name of 
quinetum. 

All the alkaloids disturb the stomach more or less; but 
quinine is the mildest. In a few cases, a decoction of the bark 
acts more powerfully than any of the alkaloids. It contains 
quinic acid and a little tannin. 

Administration. — The crystallized sulphate of quinine is used 
to a greater extent than any other of the preparations. It is 
freely soluble in water slightly acidulated with either the dilute 
or aromatic sulphuric acid. When quick effects are desired, 
this is the best way to administer it, as it is immediately ab- 
sorbed. The solid crystals are soluble in the gastric juice, 
although liable to be decomposed in part. Quinine should be 
given on an empty stomach, or after the active part of digestion 
is over. 

Quinine pills are apt to pass through the alimentary canal 
undissolved unless fresh. They should not be kept more than 
ten or fifteen days, no matter what protecting coating they may 
have. In pill form, spices should always be in combination, as 
they promote the action of the quinine. 

The intense and persistent bitter taste of the soluble salts of 
quinine often makes it desirable to administer it in a more 
palatable form, especially for children. 

The following formula is the best: 

5 Quin. Sulpk., gr. xij. 

Acid. Taimici, gr. iij. 

Syr. simplic, 3 iv. 

Aquas Cinnamom. , § i. 

M. Sig. To be shakeu. Teaspoonful dose. 



MEDICINAL REMEDIES. 87 

This preparation should not be kept long, as it sours. Keep 
in a cool place, and not longer than two or three days. 

Summary of the Uses of Quinine. 

(1) As an antiperiodic in all forms of malarial fevers and 
disorders of malarial origin. Also as a prophylactic. 

(2) As an antiseptic and disinfectant in chronic cystitis, and 
in septicemia resulting from absorption of septic material from 
deep-seated abscesses. 

(3) As an antiphlogistic and antisuppurative in psoas abscess, 
pneumonic phthisis, fistulous discharges, and whenever suppura- 
tion is prolonged. 

(4) As a restorative during and after fevers. 

(5) As a neurotic in neuralgic pains, especially if periodic, 
such as malarial headache, brow ague, etc. 

(6) As an antipyretic. 

(7) As an adjuvant to colchicum in the treatment of gout 
(seep. 139). 

(8) As a vegetable bitter to awaken appetite (see p. 88). 

V. Vegetable Bitters. 

Vegetable bitters per se do not belong to the restorative class 
of medicines, but, on account of their relation to digestion and 
nutrition, they are classed in it. 

The whole effect of the vegetable bitters is limited to the initial 
stages of digestion, viz., they awaken the appetite and have that 
effect on the nerves called " exciting a relish/' but they do not 
promote digestion directly by increasing the flow of the digestive 
secretions. This matter of exciting a relish is very important, 
for unless a patient relishes his food digestion is always slow. 
Therefore, when consulted on questions as to diet, if the appetite 
is not perverted, allow the patient to have whatever he fancies, 
for, no matter how indigestible it may be, it will agree with 
him; and, conversely, although the food prescribed may be 
theoretically correct, if the palate or stomach has a resentment 
against it — and these resentments are very chronic — the food 
will not agree. 



88 NOTES ON MATERIA MEDICA. 

In the administration of vegetable bitters, the best to begin 
with is cinchona, or Peruvian bark, especially where the anorexia 
is the result of fever. 

In nervous dyspepsia, and to awaken the appetite after fevers, 
the compound tincture is the best (dose, two teaspoonfuls 
three times a day). In dyspepsia, with rather abundant alkaline 
urine and charged with phosphates, alcohol is indicated; but, 
to prevent the alcohol habit being formed, it should be combined 
with some bitter, either quinine (dose, gr. i.) or quimdia or 
cinchonidia (dose, gr. ij.-iij.). For loss of appetite in females 
due to nervous debility arising from ovarian irritation, the 
mineral acids, combined with vegetable bitters, are beneficial. 

Quassia, gentian, and calumba are very similar in their 
qualities as bitters. They are free from tannic acid, and are 
therefore adapted for combination with iron in the treatment of 
anamiia, gentian being the one most frequently used. 

Quassia is the wood of the Picrsea excelsa, a large tree grow- 
ing in the West Indies. It has an intensely bitter taste, but 
does not disagree by producing nausea. The preparations are: 
the infusion (3ij.-Oi.), dose one or two teaspoonfuls; and 
tincture ( 3 i.-Oi.), dose one-half to a teaspoonful. As it is 
highly poisonous to insect life, a strong infusion ( § ij.-Oi.), to 
which common salt has been added, is often used as an enema 
to destroy ascarides in the lower portion of the large intestine 
and rectum, as it does not produce any local irritation. 

Gentian is the root of the Gentiana lutea, a plant growing in 
the mountainous regions of Europe. Its taste, being somewhat 
aromatic, is pleasanter than that of quassia. Its infusion is in- 
ferior to that of the compound infusion of Peruvian bark. 
When iron is to be given in connection with a vegetable bitter, 
the compound tincture of gentian should not be used. 

Calumba, or columbo, is the root of the Jateorrhiza calumba, 
a climbing plant of Mozambique. It is an admirable bitter 
in cases of chronic gastritis. As cinchona, quassia, and gen- 
tian are to be given for nervous dyspepsia, and calumba for 
the dyspepsia caused by gastritis, the distinctions between the 
two forms should be thoroughly understood, as the indiscrimi- 
nate administration of these bitters might be injurious. In ner- 



MEDICINAL EEATEDIES. 89 

vous dyspepsia, the patient feels worse before eating than after, 
the food relieving the gastric uneasiness; bufc an hour or so af- 
terward there will be a recurrence of the unpleasant symp- 
toms. In gastritis, the patient is worse after eating than 
before; pressure on the epigastric region occasions pain, the 
rectus abdominis is often in a state 'of chronic rigidity, there is 
an aggravating feeling of heaviness in the pit of the stom- 
ach, and the face has a mournful expression. When a patient has 
gastritis, do not give anything containing alcohol, and con- 
sequently the tinctures of the vegetable bitters should not be 
used. A very good combination to relieve the pain and other 
miseries of chronic gastritis, especially if ulceration is feared, is 
equal parts (ten grains) of powdered calumba and subcarbonate 
of bismuth. 

The following general rules may be laid down for the use of 
this class of medicines: 

1. If bitters fail to improve the appetite, there is no ad- 
vantage in continuing their use; for, with a few exceptions, 
their therapeutic value is limited to their influence over this 
one function. 

2. If the appetite is good but the digestion is bad, no benefit 
will be derived from the use of vegetable bitters; for the diffi- 
culty is beyond the reach of this class of remedies, being gener- 
ally in the intestines. 

3. If the secretion of gastric juice is interfered with by 
some organic disease, then the use of the bitters is useless, if 
not injurious. In fevers, there can be no appetite as long as 
the temperature remains high and suppresses the secretion of the 
digestive juices, and therefore in this stage they should not be 
given. 

4. When the fever has subsided and the recovery begins, 
then the vegetable bitters are needed to stimulate the appetite; 
but if the patient is voracious and in danger of over-eating, 
then they are contra-indicated. 

5. The tinctures of vegetable bitters are injurious in all 
cases of catarrh of the mucous membrane of the stomach, as 
gastritis, etc. In these cases the infusions are indicated. If 
the dyspepsia is nervous without gast litis, with the unpleasant 



90 NOTES ON" MATERIA MEDICA. 

sensations occurring before eating, then the tinctures are in- 
dicated. 

6. As appetizers, they should be taken two or three times 
a day, and always half an hour to an hour before each meal, so 
as to obtain the effect of the medicine and prepare the stomach 
to receive and digest the food. 

7. When it is desirable that bitters be used continuously 
for any length of time, a change should be made every ten or 
twelve days, substituting one for another. If any one form be 
given longer than this period, it loses its power over the stomach 
and becomes repulsive, as the stomach abhors monotony. 

Preparations — 

CINCHONA OR PERUVIAN BARK. 

Quassia. Extractum Quassias, . . . gr. i ,-ij. 

Extractum Quassias fluidum, . . gtt. v.-x. 

Tinctura Quassias (1 in 10), . . 3 i. 

Gentian. Extractum Gentianas, . . . gr. ix.-x. 

Extractum Gentianas fluidum, . gtt. x.- 3 ss. 

Tinctura Gentianae composit a, . . 3 i-— 3 ij. 

Stoughton's Elixir is also a good prepa- 
ration. 

Calumba. Calumba powdered, . . gr. x.- 3 ss. 

Extractum Calumbse fluidum, . gtt. xv.- 3 ss. 

Tinctura Calumbas. . . . 3i.-|ss. 

VI. Mineral Acids. 

The principal members of this group of the restorative class 
of medicines are hydrochloric acid, sulphuric acid, nitric acid, 
nitro-muriatic acid, and phosphoric acid. The three acid secre- 
tions of the body are the gastric juice, the urine, and the per- 
spiration. The' gastric juice depends for its acidity on the 
presence of a small quantity of free hydrochloric acid, probably 
formed by the decomposition in the system of sodium chloride; 
the acidity of the urine is due to the presence of acid sodium 
and potassium phosphates; that of the perspiration to various 
organic acids. The acidity of the urine is liable to temporary 
variation from the use of certain fruits and vegetables, but 
otherwise the alkalinity of these secretions is a morbid condition, 



MEDICINAL REMEDIES. 91 

and its continuance is incompatible with health. The most 
frequent cause of this condition is depressed nervous vitality, 
and the exhibition of the mineral acids is indicated to counter- 
act the alkalinity. Thus patients who have indulged in exces- 
sive venery often have wet hands and feet from a cold, clammy 
perspiration, alkaline instead of acid in reaction. There is also 
not infrequently a deficiency of acid in the gastric juice, giving 
rise to a peculiar form of dyspepsia different from that de- 
pendent on organic changes, such as gastritis, etc., as the patients 
are relieved by food. Mineral acids should be given in these 
cases as appetizers and to promote digestion. The effect of 
moist heat is another illustration of alkalinity of these secretions 
following depressed nervous vitality, as it not only makes the 
gastric juice and urine alkaline, but also reduces the acidity of 
the blood where it is charged with acid salts, as in gout and 
rheumatism. Hence the use of the warm bath in these diseases. 
This also accounts for the inability of the stomach to digest 
food taken shortly before a bath. The rule in the treatment of 
nervous debility — a condition in which the vitality of the system 
is reduced either by an excessive drain of nervous force or by 
faulty nutrition — is to examine the urine. If neutral or alkaline, 
and there is a weak, compressible pulse, alcohol unfortunately is 
the only remedy. It should be given with the food, and to aid 
digestion mineral acids should also be given. If the urine is acid 
and of high specific gravity, the administration of alcohol and 
the mineral acids is injurious. It is to be remembered that 
when an acid secretion becomes alkaline as the result of disease, 
it is very difficult to restore its normal reaction, while, on the 
other hand, an acid secretion is easily rendered alkaline by the 
action of any depressing influence. 

All the mineral acids are more or less astringent, and may be 
used to arrest fluxes and hypersecretions. 

Hydrochloric Acid. — This acid is a natural ingredient of the 
body, and subserves some very important digestive functions. 
In certain diseases it disappears, in others it is in excess. Can- 
cer in any part of the body causes a deficiency of hydrochloric 
acid in the gastric juice, and this enables us to ascertain whether 
a disease of the stomach is malignant or due to a small ulcer. 



92 NOTES ON" MATERIA MEDICA. 

Hydrochloric acid is also absent in typhoid fever. It has been 
demonstrated by experiment that the stomach is more wasted 
in this fever than in any other. This acid combined with pep- 
sin should therefore always be given in typhoid fever. In certain 
forms of dyspepsia, hydrochloric acid is in excess; in other 
forms there is a deficiency. How can we tell the difference? 
The patients are more often women than men, and come from a 
nervous family. They will complain of considerable distress 
after eating, of a burning sensation in the stomach, of temporal 
headaches, of having thrown up intensely acid material, and 
withal they are very hysterical. If the breath and vomit have 
a sour smell, it is due to acetic acid fermentation in the stomach 
caused by the absence of hydrochloric acid and pepsin, the nat- 
ural antiseptics of the stomach. On the other hand, if there is 
an excess of hydrochloric acid, the vomited matter will be of 
acid reaction; but it does not smell sour, as hydrochloric acid is 
not so volatile as acetic acid. In the latter condition, alkalies, 
particularly in the form of the alkaline mineral waters, are in- 
dicated. In the former, vegetable bitters, bismuth, and hydro- 
chloric acid should be given, of course not with any hope of cur- 
ing the disease where the absence of the acid is due to cancer. 
Repeated vomiting, two or three times a week, of large quantities 
of fermentative material is due to a form of dyspepsia that can be 
cured in no other way than by washing out the stomach— a plan 
which has succeeded where everything else has failed. Prepa- 
rations : Acidum Hydrochloricum, gtt. v.-x. ; Acidum Hydro- 
chloricum dilutum, gtt. xv. 

Sulphuric Acid. — Though not a natural ingredient of the 
body, this acid has the same power to increase the appetite and 
aid digestion as hydrochloric acid. It also possesses decided 
astringent properties, being especially good for two fluxes, pas- 
sive diarrhoea and hyperidrosis. It is the popular remedy for 
the sweats of phthisis. For this purpose it should be given 
three or four times during the day and sometimes during the 
night. 

Nitric Acid. — This acid possesses decided advantages over 
hydrochloric and sulphuric acids as an astringent, particularly 
to check excessive secretion of the bronchial mucous membrane. 



MEDICINAL REMEDIES. 93 

It is therefore to be recommended for bronchorrlma, and in 
those cases of bronchial relaxation in old persons with feeble 
heart who cough incessantly during the night and raise a great 
deal of watery mucus. Kitric acid is not to be given where 
there is a cough with viscid secretion, as the cough is only 
aggravated and the secretion becomes more tenacious. In 
chronic bronchitis, where secretion is excessive, nitric acid and 
iodide of potassium combined do a great deal of good. Before 
the introduction of cod-liver oil, nitric acid used to be the 
great remedy for phthisis, but it should only be used in this 
disease when there is excessive mucous secretion. It is also use- 
ful in whooping-cough to check secretions, if they are too free. 
In serous diarrhoea (summer diarrhoea), where there is need of an 
astringent, nitric acid is frequently used and may be added to 
the usual prescription. 1 Preparations : Acidum Nitricum, gtt. 
v.-x.; Acidum Nitricum dilutum, gtt. x.-xv. 

Nitro-muriatic Acid. — This acid is prepared by adding one 
part of strong nitric acid to two parts of strong hydrochloric 
acid, or, as it is generally prepared, by taking five parts of the 
latter to three of the former. They unite with effervescence 
and evolution of orange-colored fumes, and an entirely new sub- 
stance is formed. That it is a definite chemical compound and 
not a mixture is proved by its independent and characteristic 
qualities, as well as by the fact that, if the acids be first diluted 
before mixing, no such action takes place. On the other hand, 
the nitro-muriatic acid made from the concentrated acids can 
be diluted to any extent without losing any of its physiological 
or chemical properties. If the nitric and muriatic acids are not 
of sufficient strength to form this compound, by adding a few 
drops of sulphuric acid (which takes up the excess of water) 
the desired strength can be obtained, and the two acids unite 
with the characteristic reaction. If the acids do not instantly com- 
bine, do not put a cork in the bottle, as they sometimes combine 
afterward, bursting the bottle, if it is closed, and occasionally 
producing very unpleasant results. This compound is unstable, 
and undergoes partial decomposition if kept too long. It is 
better to make it fresh as occasion requires. 

1 See p. 237 for prescription for summer diarrhoea. 



94 NOTES OX MATERIA MEDICA. 

This acid is a powerful oxidizer, and its ralue is chiefly in its 
stimulation of the action of the liver, and of the glandular 
structures of the alimentary canal. Many disorders of the sys- 
tem are due to the defective oxidizing power of the liver; retro- 
grade material which ought to be converted into urea being 
formed instead into uric acid, and this material, if greatly in ex- 
cess, gives rise to the gouty diathesis with its attendant disor- 
ders. One of these disorders is oxaluria, the marked feature of 
which is depression of spirits and hallucinations. The passage 
of oxalic acid crystals down the ureters produces haemorrhage 
and more disturbance than uric-acid calculi. Nitro-muriatic 
acid given one hour after each meal counteracts oxaluria. How 
it does so we do not know. It certainly increases the flow of 
bile, and may therefore also be used in slight attacks of jaundice. 
Preparations : Acidum Nitrohydrochloricum, dose, gtt. iv. ; 
Acidum Nitrohydrochloricum dilutum, dose, gtt. x.-xv. 

Phosphoric Acid. — This acid has few therapeutical uses com- 
pared with the other mineral acids. Apparently it has no power 
to increase the appetite, promote digestion, or affect any of the 
secretions. It is to be recommended only as a cooling drink for 
the thirst of fever (Acidum Phosphoricum dilutum, 3 i.; Aqua, 
Oi.). 

Administration" of the Mineral Acids. 

The mineral acids should never be given in concentrated 
form, as there is an officinal dilute preparation of each, of 
which the dose is on the average fifteen minims. 1 Even the 
dilute preparations must be still further diluted to avoid in- 
juring the teeth. When these remedies are used for any length 
of time, it must be remembered that the system cannot bear an 
excess of acid, so that upon the first symptoms of intolerance, 
griping, and diarrhoea with strongly acid urine, their exhibition 
must be stopped at once and for a long time. Otherwise the 



1 In prescribing the dilute preparations, remember that the dilution is with 
water, sixty drops to the drachm. Aromatic sulphuric acid is really a tinc- 
ture, as it has an alcoholic menstruum, and there are consequently one hun- 
dred and twenty drops to the drachm. 



MEDICINAL REMEDIES. 95 

hyperacid urine will cause irritation of the kidneys, with forma- 
tion of uric-acid gravel and perhaps calculous deposit. Patients 
with oxalic-acid diathesis must be cautioned against the pro- 
tracted use of the mineral acids, as the relief afforded often 
leads them to their use independently of the physician's advice. 

Til. Alkalies. 

During life the reaction of the blood is strongly alkaline. 
This condition is necessary to life, for, before the blood is reduc- 
ed even to neutrality, death takes place. 

Alkalies are therefore natural to the body, and when they are 
deficient, or the acidulous radicals are in excess in the blood, 
their use is indicated. 

This condition is characteristic of acute articular rheumatism, 
pyemia, scarlet fever , scarlatinal rheumatism, and gonorrheal 
rheumatism, and the danger in these cases is in direct proportion 
to the acidity of the secretions, endocarditis being induced. 

The only reliable treatment of these disorders is the alkaline, 
and no plan or system of treatment in rheumatism has proved 
as efficient in preventing cardiac complications. 

Salicylic acid and the salicylates possess in a marked degree 
the power of controlling the pain of acute rheumatism, but they 
do not prevent or arrest endocarditis, except by shortening the 
average duration of the rheumatism. 

The most reliable guide in the treatment of rheumatism is the 
reaction of the urine. If the urine be rendered alkaline, and 
kept so during the entire course of the disease, the danger of 
cardiac complications is reduced to the minimum. 

A mixture of several of the alkaline salts is usually given; a 
small dose of paregoric, 3ss.-3i.,may be added to prevent 
purging. 

The following is the usual formula: 

I£ Potassii Bicarbonatis, 3 iss. 

Potassii Acetatis, ...... 3 ss. 

Potassii Nitratis, gr. xx. 

Acidi Citrici, 3i. 

Liq. Ammonii Acetatis, ..... § ij. 
M. 



96 NOTES ON MATERIA MEDICA. 

The whole should be taken at one dose, and repeated every 
one, two, three, or four hours until the urine is alkaline. It 
should be rendered alkaline as soon as possible, and kept so 
until the attack is over. 

If necessary, the frequency of the doses may be increased or 
diminished, but not their magnitude. 

In gouty diatheses, the quantity of uric acid formed is so 
great that the urine cannot hold it in solution, and gravelly 
deposits result. 

The alkalies increase the solvent powers of the urine for these 
deposits, and should be given as prophylactics against calculi, as 
well as to diminish the renal and vesical irritation. The vege- 
table salts are to be preferred to the carbonates, as they act 
more readily on the kidneys. Eipe fruits, since they contain 
more or less citrates, tartrates, and malates of potash, are useful 
in a gouty diathesis. If the vegetable salts do not succeed, the 
liquor potassae, in doses of half a drachm to a drachm freely 
diluted in water, will act. The objection to it is that it is 
likely to interfere with nutrition. 

Those skin diseases which are due to a gouty diathesis, as 
gouty eczema , lepra, psoriasis, may be benefited by the use of 
the alkalies, both internally and locally. If the secretion from 
the diseased surface is acid, sodii bicarb. (3ij--Oi.) is a good 
wash. If stronger than this, it will often irritate. Abstinence 
from animal food will often render the secretions alkaline, and 
the cutaneous eruptions will disappear. Acidity of the alimen- 
tary canal, shown by sour eructations, sour vomiting, acid and 
irritating stools, is caused by fermentations due to deficiency of 
digestive juices, which, when present, act as antiseptics and 
prevent all such decomposition; with the treatment to restore 
the secretions, temporary relief may be obtained from the use 
of alkalies. Lime is to be preferred on account of its power in 
neutralizing acids. Ordinary lime-water is sufficient, but Clel- 
land's saccharated solution is preferable. It is made by rubbing 
together eight ounces of quicklime to five of sugar, and adding 
gradually one gallon of water. Each ounce contains eighteen 
grains of lime. (Dose, gtt. xx -xxx., well diluted with water, 
two or three hours after meals.) It is often useful to correct 



MEDICIXAL REMEDIES. 97 

acidity accompanying sick headache. In children, especially 
when artificially fed, acidity is very likely to be due to too much, 
casein in the milk. Cow's milk contains much more casein, but 
less fat, sugar, and salt, than human milk. Cream should be, 
therefore, added, together with sugar and a little salt, and the 
whole diluted with three parts of water. If there is a tendency 
to acidity, lime-water may be used to dilute the milk. It is 
readily prepared by roasting an oyster shell, pulverizing, and 
adding water, which can dissolve a limited proportion of lime, 
never enough to be irritating. 

Chalk, being a mild antacid, is used in doses of gr. iij.-v. 
for children, gr. x.-xv. for adults. The officinal chalk mix- 
ture is a very popular remedy in acid diarrhoea (dose, 3ss.-i.). 
A mixture of equal parts of lime-water and olive oil makes an 
excellent local application for burns and for inunction of the 
skin in scarlet fever and small-pox. If necessary, antiseptics 
may be added. One of the best means for curing scabies is the 
following: Rub together powdered quicklime, 3 viij., and 
washed sulphur, 3 iv ; then add, stirring constantly, one gallon 
of boiling water. When cool, decant the clear liquid, which is 
to be rubbed over the whole surface of the body. The evapora- 
tion of the fluid leaves a fine powder on the skin, which may be 
washed off after an hour or so. The first general application, 
if thorough, is generally sufficient. There may be patches 
which need the local application of it. It is not irritating to 
the skin. 

Till. Mineral Waters. 

These are remedies which constitute a class by themselves^ 
having the properties of the organic or disease class of medi- 
cines, as they produce distinct and very pronounced changes in 
the body itself, and are used for chronic, not for acute forms of 
disease; and the properties of the eliminative class of medicines, 
as they increase gland secretion. Mineral waters are more par- 
ticularly indicated for those diseases of advanced life dependent 
almost exclusively upon a disturbed portal circulation, being 
rarely indicated in youth, never in childhood. The portal cir- 
culation is more likely to be disturbed than any other, by reason 



9S NOTES ON MATERIA MEDIC A. 

of its receiving its sole impetus from the heart, and not being 
aided by muscular pressure, as occurs in other parts of the 
venous circulation. It is, however, aided indirectly by vigorous 
exercise, which increases the propulsive power of the heart; and 
so, among those who lead active lives, as sailors, farmers, etc., 
diseases for which mineral waters are beneficial, are rare, while 
among those who lead sedentary lives, with little or no physical 
exertion, they are very common. The ingestion of more nitro- 
genized food than the system demands may also be the cause of 
a disturbed portal circulation, and often these two causes are 
combined. A sluggish portal circulation must necessarily inter- 
fere with the functions of the liver, one of the most important 
of which is the separation of effete nitrogenized matter from the 
blood; and the imperfect discharge of this function is always 
indicated sooner or later by the accumulation of urates and 
oxalates in the blood, and by an excess of uric and oxalic acids 
in the urine — a condition which, if continued, induces a gouty 
diathesis, biliousness, constipation, piles, slow digestion, loss of 
elasticity of mind, etc., with a pulse of high tension. Not 
infrequently patients with these symptoms are given medicines 
to improve digestion, etc., and, failing to obtain relief by this 
treatment, they go to a mineral spring or some hydropathic es- 
tablishment, where they are markedly benefited; for water itself, 
if taken in sufficient quantity, by increasing the fluidity and 
consequently the solvent power of the blood, is often an effec- 
tive remedy in these cases, as the increased solvent power of the 
blood causes a more rapid oxidation and tissue waste in all parts 
of the body, and the increased fluidity greatly aids the elimina- 
tion of this waste material by the kidneys. Upon this action of 
water the remedial properties of mineral waters principally de- 
pend, many noted medicinal springs containing nothing but 
pure water. The general effect of mineral waters, therefore, is 
to increase the waste of the system, notably of urea and other 
nitrogenous compounds; hence they should never be given in 
wasting diseases, such as phthisis, and in suppurative diseases 
(especially if cancerous or where there is a tendency to haemor- 
rhage), or where there is considerable exhaustion of the system, 
nervous or otherwise, in which they are positively mischievous; 



MEDICINAL REMEDIES. 99 

but for certain forms of disease there is nothing to equal them, 
each of the different kinds of mineral waters having clearly 
denned uses. 

Mineral waters may divided into five classes: 

I. Simple saline waters. 

II. Alkaline or purgative waters. 

III. Sulphurous waters. 

IV. Chalybeate waters. 

V. Bathing waters. 

I. Simple Saline Waters. — In these, common salt is the most 
abundant solid ingredient, the most valuable waters of this class 
being those in which the proportionate quantities of chloride of 
sodium and the other salts most nearly resemble those existing 
in human blood when deprived of its organic ingredients. 
Hence they possess restorative as well as eliminative properties. 
Common salt is absolutely necessary to the system, total depri- 
vation producing a tendency to ulceration and epithelial dis- 
ease. In addition to its other properties, it also undoubtedly 
aids osmosis, and upon this depends the greater part of its re- 
medial power; for although saline waters, by diminishing the 
force of the heart's action, make the pulse more feeble and com- 
pressible, their principal function is to increase the chemical 
interchange constantly going on in the body, and, by increasing 
the processes of transudation, to powerfully stimulate the inter- 
stitial circulation. Hence wherever this is sluggish, and in all 
cases of passive venous congestion, saline waters operate very 
beneficially. The principal waters of this class are the Congress > 
Geyser, and Hathorn waters of Saratoga, and the foreign waters 
of Kissingen. The disorders most benefited by saline waters 
are: 

1. Piles : This complaint is an indication of an extremely 
slow portal circulation, the hsemorrhoidal veins being the ter- 
minal ones of the portal system. Saline waters, by stimulating 
the portal circulation, remove the cause, and thereupon the 
effect disappears. 

2. Enlarged prostate gland: Whatever causes piles will 
eventually cause enlarged prostate (and when this occurs in a pa- 
tient over sixty years of age it is always dependent upon a slow 



100 XOTES OX MATERIA MEDIC A. 

portal circulation), as a slow venous circulation always causes 
hypertrophy of connective tissue, owing to the inactive return 
current of the interstitial circulation. Hence saline waters are 
indicated to stimulate this circulation. They are also indicated 
for chronic cystitis and iveakness of the Madder. 

3. Gynecological ailments, where these are dependent upon 
slow portal circulation, such as chronic congestion of the uterus, 
prolapse of the uterus, leucorrhoea, etc., and many of the troubles 
at the time of the menopause. If there is no wasting disease, 
saline waters may be given to enfeebled women. 

4. Chronic Bright's disease : This structural degeneration 
of the kidneys comes on slowly, and nearhr always is the result 
of constant irritation of the kidneys for months or years by im- 
perfect intestinal digestion, especially of the nitrogenous ele- 
ments of food. In the nephritis produced by gout, we have 
distinct evidence of the genesis of Bright's disease; but this dis- 
ease is also caused by retrograde materials other than uric acid, 
many poisons being added to the circulation through imperfect 
intestinal digestion and other causes. 1 For instance, the coloring 
matter of the urine comes from the intestines, and one of the first 
evidences of this disease is not so much the appearance of al- 
bumin in the urine — for this is not always present — but the ab- 
sence of color, with persistent low specific gravity. If taken in 
its early stages before nutrition begins to suffer^ the further 
progress of this disease can often be prevented by a judicious 
course of mineral waters. 

5. Chronic endarteritis: This general vascular disease, 
when coincident, as it almost invariably is, with Bright's dis- 
ease, is caused by chronic toxaemia, partly due to the imperfect 
action of the kidneys, partly to imperfect intestinal digestion, 2 
the latter being caused in its turn by sluggish portal circula- 
tion. There can be no better preventive of this disease than a 
good course of saline waters, once or twice a year, in some cases 
every four months. 

6. Chronic shin ailments, when dependent upon imperfect 

1 See article on Intestinal Fermentation, p. 27. 

2 Hence the importance of giving proper diet in this disease, fermented 
milk being the best form of food. 



MEDICINAL REMEDIES. 101 

assimilation in the intestines. One very common, typical form, 
extremely annoying to those suffering from it, is redness of the 
nose, most marked after meals, and due to the formation of va- 
rious acids in the intestines from the absence or diminution of 
the digestive secretions. Local treatment will only benefit tem- 
porarily, a course of mineral waters being indicated to perma- 
nently cure this affection. This condition also occurs in some 
women at the time of the menopause. All forms of chronic ec- 
zema dependent upon a gouty condition of the system are bene- 
fited in the same way. 

7. Chronic bronchitis, when the result of a lithasmic condi- 
tion of the blood. This form of bronchitis is often due to a 
family peculiarity, the gouty condition of the system manifest- 
ing itself in this form instead of chronic rheumatism or gout. 
At the beginning, there will be a cough, lasting only through 
the winter months, but it gradually encroaches on the remaining 
months of the year, until finally the patient has it all the time, 
resulting in chronic degeneration of the lung tissue, and ulti- 
mately general emphysema. Mineral waters should be given, 
not for the bronchitis itself, but for the bronchial irritation 
caused by the presence in the blood of poisonous substances. 

8. Chronic gastritis, dependent upon interference with the 
return circulation from the stomach to the liver, and chronic sore 
throat, with chronic catarrh of the larynx or pharynx, are also 
benefited by saline waters made hot and sipped slowly, as this 
not only stimulates the portal circulation, but also stimulates 
the affected mucous membranes. If the complaint is tuber- 
cular, however, no benefit will be obtained. 

As ehminatives, alkaline waters enter the intestine, and, owing 
to their affinity for the water in the intestinal secretions, 
they arrest the osmotic circulation between the intestines and 
the blood-vessels, and therefore are sure to be sent out of the 
system, as they do not enter the circulation, and thus act as in- 
ternal enemata. ' On this account, alkaline waters are the least 
prostrating of all cathartics, as they abstract nothing from the 
blood, produce no nausea, and so are particularly recommended 

1 See also article on Saline Cathartics, p. 242. 



102 NOTES OX MATERIA MEDICA. 

for the removal of faecal accumulations and for chronic consti- 
pation. 

II. Alkaline or Purgative Waters. — These contain, besides 
chloride of sodium, a considerable amount of the carbonates of 
sodium and magnesium and other salts. They are more 
prompt and energetic in their action than the saline waters, 
but also more debilitating to the digestive functions. The 
most important domestic mineral waters of this class are the 
Bladon Springs, California Seltzer, Perry Springs, Alkaline 
Springs of Wisconsin, etc. ; Friedrichshalle and Hunyadi Janos 
being the most important foreign waters of this class. These 
waters are useful in the treatment of chronic rheumatism ; and 
in cases of diabetes where patients are not losing weight, alka- 
line mineral waters, such as Carlsbad, sometimes do good. As 
eliminatives they produce considerable purgation, particularly 
if taken warm, the movements being painless, unaccompanied 
by griping, and rapidly induced. 

III. Sulphurous Waters. — These usually contain, besides chlo- 
ride of sodium, a considerable quantity of the sulphates of 
sodium, calcium, and magnesium; and some waters of this class 
also hold sulphuretted hydrogen or metallic sulphides in solu- 
tion. The most important springs in this country are the hot 
springs of Kentucky, Michigan, and Virginia; Sharon, of New 
York; in England, the sulphurous waters of Harrowgate. This 
class is very useful in the treatment of that form of chronic rheu- 
matism which attacks the joints very slowly, ultimately, however, 
producing permanent distortion. These and the strong alkaline 
waters may be combined to counteract a tendency to chronic 
gout, the patient deriving benefit in proportion as he loses weight; 
but if the patient is already wasting, their exhibition must be 
moderate. These waters must be used with a good deal of dis- 
crimination, as they produce muscular prostration which may 
amount to paralysis, and accordingly are contra-indicated in fatty 
degeneration of the heart and where the arteries are atheromatous. 

IV. Chalybeate Waters. — These waters contain more or less 
salts of iron, principally the carbonate and sulphate. They a:e 
useful in those diseases for which iron is usually administered, 
but must be used with caution, as they very soon produce dis- 



MEDICINAL REMEDIES. 103 

turbances of digestion and circulation, indicative of the system 
being overdosed with iron. There are several domestic fer- 
ruginous springs in Pennsylvania and elsewhere, the principal 
ones abroad being those of Tunbridge Wells, England, and the 
Spa, Belgium. 

V. Bathing Waters. — The remedial properties of baths, mineral 
or otherwise, have nothing whatever to do with the substances 
they contain. The effect of baths is to produce alkalinity of 
urine and other acid secretions, and to counteract the hyper- 
acidity of the blood, and this result will follow even if the bath 
be of vinegar; hence warm baths are of use in the treatment of 
chronic rheumatism. Warm- water baths are always prostrat- 
ing to the patient; but if salt is added, their depressing effect is 
to a large extent overcome. 1 



Di vision II. — A Iteratives. 

Alterative medicines, or, as they are sometimes termed, 
specific medicines, are disease medicines which are unnatural to 
the system. Symptom medicines are also unnatural to the 
system, but they are not disease medicines. Restoratives are 
disease medicines, but they are not unnatural to the system. 
Alteratives are termed specifics, not that they have the property 
of acting specifically against any one disease, but because their 
range of operation is limited. They act in an unknown way, 
only against certain special diseases or morbid conditions. Thus 
potassium iodide acts promptly against syphilitic periostitis, 
but not to the same degree in other forms of periostitis; colchi- 
cum is the remedy for gouty arthritis, but not for rheumatic 
arthritis; and so with the other remedies of this class. These 
medicines are not given for the symptoms of disease, but for the 
disease itself; for they do not relieve symptoms except by re- 
moving the disease. Being unnatural to the system, they are 
therefore more or Jess poisonous , and this fact is to be re- 
membered, because, though all symptom medicines are also 

1 See also article on Moist Heat, p. 287. 



104 NOTES ON MATERIA MEDICA. 

unnatural to the system, yet complete recovery from the most 
active of them, like opium or aconite, is a quest. on of hours 
only, while recovery from the injury of organic poisons may be 
very slow. When the latter act as poisons they produce charac- 
teristic symptoms, such as salivation by mercury, or iodism, 
bromism, etc. The great rule to be observed in the administra- 
tion of these medicines is that they should never produce symp- 
toms. When they do so they cease to act as remedies, and the 
dose should therefore be lessened to that which does not cause 
symptoms, or else their use must be abandoned. Give these 
medicines up to the point of producing symptoms, to ascertain 
the dose, as, owing to personal idiosyncrasies, this may vary 
considerably in different patients. As their poisonous effects 
are both different from their remedial effects and inconsistent 
with them, if they are given for any length of time the danger 
confronts us of producing an artificial disease. An important 
rule, therefore, to be observed in their lengthened administra- 
tion, is to conjoin restoratives with them to postpone their poi- 
sonous effects as long as possible. 

The most important medicines of this class are: 

1. Mercury. 5. Silver, 

2. Iodine and compounds. 6. Zinc. 

3. Bromides. 7. Copper. 

4. Arsenic. 8. Bismuth. 

9. Colchicum. 

I. Mercury (Hydrargyrum). 

Mercury is the most t} T pical of the specifics. Its precise 
action is unknown, but its use is sustained by clinical facts. 
Small doses have been found to increase the number of red 
blood corpuscles. Mercury appears to act by preventing their 
destruction. 

Uses of Mercury. 

As an Antisyphilitic. — Mercury is the only antidote against 
constitutional syphilis in all its stages, and the only medicine 
that will eradicate it from the system. The various prepara- 



MEDICINAL REMEDIES. 105 

tions of mercury have been employed in the treatment of 
syphilis, calomel especially, as it is less likely to interfere with 
digestion. It is given in the form of powders containing one- 
twentieth of a grain each; two powders are taken three times 
per day for three days. On the third day, and every day there- 
after, increase one powder until the symptoms of mercurialization 
occur, which, in the case of calomel, are a metallic taste in the 
mouth and a disagreeable fetor to the breath; this will be fol- 
lowed by tenderness of the gums, the teeth becoming tender 
and apparently longer, and, if still continued, the mouth secretes 
saliva, which commences to run very profusely. Salivation 
should never be sought for, as it produces great constitutional 
depression and in some cases becomes almost incurable. There- 
fore in giving calomel it should never be pushed beyond the 
metallic taste in the mouth, and as soon as this symptom makes 
its appearance the close should be decreased one powder or 
more. 

This gradual testing of the susceptibility of the patient is 
very important in administering calomel. When given in this 
manner, the patient loses the unpleasant symptoms, gains in 
flesh and strength, and does not show that cachectic appearance 
so characteristic of syphilis when fully developed. He should 
only be conscious of the action of the medicine by the daily 
improvement which he experiences. In nocturnal syphilitic 
hemicrama, one-thirtieth of a grain of calomel every fifteen 
minutes often gives relief when the iodide of potassium has 
failed. 

When very rapid mercurialization is desired, inunction w T ith 
mercurial ointment should be tried. The skin should be thor- 
oughly washed with soap and water for at least ten minutes be- 
fore each application. The ointment should not be allowed to 
remain on the skin more than twenty- four hours, and after its 
removal the skin should be thoroughly washed again. The 
amount usually employed for each application is one half a 
drachm to a drachm. It should be applied, by preference, on 
the inside of the arms, on the thighs, and on the fore part of the 
body, rather than the back. 

The profession generally prefers the bichloride or the binipdide 



106 NOTES ON MATERIA MEDICA. 

of mercury, as they are very reliable in their action and the 
least to be affected by personal idiosyncrasy. One-thirty- 
second of a grain of the bichloride or the biniodide is adminis- 
tered three times per day after meals, and the dose gradually 
increased to one-twenty-fourth, one-twentieth, one-sixteenth, 
etc., until symptoms of mercurialization appear, "which, in the 
case of the bichloride or the biniodide, are a disagreeable odor 
to the breath; more commonly there is a sense of pain and con- 
striction in the throat, and, coincident with this, in many cases 
there will be pain and griping in the bowels, cough accom- 
panied w 7 ith bloody expectoration, bronchitis with a tendency 
to bronchial haemorrhage, and, lastly, irritation of the kidneys 
with blood in the urine. 

Mercurial salivation produces profound constitutional pros- 
tration; this will not happen if proper treatment is adopted. 
In some cases of salivation, the teeth come out and necrosis of the 
jaw is produced. The best treatment by far is to have the 
mouth washed incessantly with chlorate of potash in camomile 
water ( 5 i. of camomile flowers to a pint of cold water, and 
three teaspoonfuls of chlorate of potash added to it). The 
patient should keep washing his mouth with this, and at times 
swallow a small quantity of it. Along with the bad taste in the 
mouth, and before salivation, some persons have griping of the 
bowels. If they do, salivation is arretted, but the constitutional 
effects of mercury are lost. This is quite noticeable in chronic 
poisoning by corrosive sublimate, and on that account it does not 
always produce salivation. The dose should never be carried 
beyond the production of a slight fetor to the breath. 

The mercurial treatment should be kept up for eighteen 
months to two years. When mercury is used for any length of 
time, it is necessary to give restoratives in order to prevent the 
development of any of the poisonous effects of the specific. The 
best for this purpose is quinine, which seems to make up the 
deficiency which mercury causes when given alone. Two grains 
of quinine should be administered in solution t. 1. d. either with 
the mercury or after it. Cod-liver oil may also be given if there 
is much anaemia, but it usually interferes with digestion in syph- 
ilitic subjects. Iron is sometimes required. Alcohol is always 



MEDICINAL REMEDIES. 107 

contra-indicated in syphilis, and should only be given when 
necessary. 

Inflammation ivithout Suppuration. — Inflammation without 
suppuration may take place in any part of the body, and begins 
with hyperemia, followed by an increase in the number of proper 
cells of the affected part and fatty degeneration, and finally by a 
marked increase in the connective tissue, producing cirrhosis 
if the affected part is glandular in structure, or sclerosis in the 
nervous system. Coincident with the cirrhotic process in the 
organs and tissues of the body, the walls of the arteries and cap- 
illary blood-vessels become the seat of characteristic changes, 
consisting of chronic endarteritis, with an exudation of hyaline 
material on the outside of the blood-vessels. The coats of the 
affected vessels become very much thickened and their calibre 
diminished, and, in the case of the smaller arteries, the cavity is 
completely obliterated . This increase of connective tissue in the 
various organs of the body never occurs without injury to the 
proper cells of the part pressed upon, and as this shrinks the 
process goes on, and uses up what is left of the proper cells of 
the part inflamed, until there is ultimately nothing but a mass 
of fibrous tissue left. 

This condition of arterio-capillary fibrosis is a constant com- 
panion of chronic Bright* s disease, especially of the cirrhotic 
variety. This gives the hard, incompressible pulse of Bright's 
disease, and causes more or less derangement in the blood supply 
of the different organs. The diseased condition of the arteries 
is the commonest cause of apoplexy in Bright's disease, and 
interference with the circulation of the brain gives rise to certain 
cerebral symptoms which are the earliest indications of chron- 
ic Bright's disease and of threatening apoplexy: 1st. Impair- 
ment of memory, due to ansemia and malnutrition of the brain. 
2d. Vertigo, especially in the morning just after rising. 3d. A 
persistent tendency to wake too early in the morning, sometimes 
with headache, which passes off soon after rising; the patient 
also suffers from cramps in the legs, especially in the calves, just 
after or before getting out of bed. 4th. A vague sense of fear, 
as of some impending danger. The intellect is dull and more 
or less impaired. 



108 NOTES OX MATERIA MEDICA. 

Against this very frequent cause of declining health in middle 
life, producing premature old age, mercury is a constitutional 
medicine of the highest value. This is illustrated by examina- 
tion of the urine in cases of chronic nephritis. Albumin and 
casts are usually found, and also, a much more serious symptom, 
want of normal specific gravity, always low, 1.010-1 012, in this 
condition; the urine will also be of very light color. 

The first effect of the bichloride is to bring back the natural 
color of the urine. 

Urea is not the cause of uraemia, but it is the poison connected 
with the coloring matter. 

The color not only improves, but the specific gravity rises; it 
may rise to 1.018.. If these changes happen, the prognosis is 
generally good. Therefore, in all cases of chronic Bright' s dis- 
ease, cirrhosis of the liver, chronic affections of the lungs and 
pleura, chronic nervous diseases, chronic endarteritis, chronic 
meningitis the result of pachymeningitis or sunstroke, mercury 
is the remedy to be given; also in epilepsy traced to injuries 
about the head and characterized by muscular twitchings about 
the face and in the extremities at night. In locomotor ataxia 
and diseases of the spinal cord, mercury in constitutional doses 
should be given for a long time, one to three years if necessary. 
The following is useful in chronic interstitial nephritis: 

$ Hydrargyri Bichloridi, gr. i. 

Pulv. Digitalis, gr. xxiv. 

Pulv. Scillse gr- xxiv. 

Quininae Sulph., gr. xxiv. 

Misce et fiant pilulse No. xxiv. Sig. One pill three times per day. 

As a Symptom Medicine. — Certain preparations of mercury 
act as symptom or functional medicines, i.e., calomel, blue pill, 
and mercury with chalk (for their uses and actions, vide Cathar- 
tics and Diuretics). 

As an External Remedy, mercury is used in two classes of mor- 
bid conditions. 

1. In diseases of the shin, due to animal or vegetable para- 
sites : scabies, favus, and inflammation of the follicles of the eye- 
lashes. 

The citrine ointment and that of the white and red precipi- 



MEDICINAL REMEDIES. 109 

tate are very useful in these and other allied affections. Other 
forms of skin disease, though not of primary parasitic origin, 
are very much aggravated by the development of fungus spores, 
which cause decomposition of albuminoid substances with the 
production of acrid, irritating discharges. Thus herpes, psori-- 
asis, and rheumatic eczema may become very troublesome and 
obstinate from this cause. The oleate of mercury can be used 
to advantage in rheumatic eczema. The citrine ointment is, for 
skin diseases, diluted with equal parts of zinc ointment, and 
five grains of salicylic acid added to the half ounce. The oint- 
ment of the white precipitate may be used in full strength. 

When fibrous induration of a part results from chronic in- 
flammation, the local use of mercurials is often efficacious in 
promoting resolution. It seems to stimulate the interstitial cir- 
culation. 

If there is only passive engorgement remaining after the sub- 
sidence of inflammation, a mild preparation, such as the simple 
mercurial ointment, is best. But if the arteries are paralyzed, 
and there is a hard and shrinking exudation, the oleate of mer- 
cury is better, being a stimulant and acting as a counter-irritant. 
It is especially useful in orchitis and epididymitis, in rheumatic 
stiffening of the joints, and in chronic pleurisy ; the pleurisy 
in phthisis causes an exudation on the visceral surface of the 
pleura, and this soon communicates inflammation to the costal 
surface, and the two surfaces of the pleura adhere. Mercury by 
inunction should be employed in all cases of phthisis where 
pleuritic adhesions exist. 

As the bases of the lungs never get well after an exudation of 
chronic pleurisy, so in disturbance of the intestines, after chronic 
peritonitis, patients will never be well for the rest of their lives. 
There will always be a tendency to constipation, colic, frequent 
loss of appetite, notably in inflammations about the uterus, the 
result of cellulitis, with pain on either side about the ovaries. 
In these cases, mercury should be used externally in the form of 
the oleates. 

In pericarditis, the whole surface of the skin over the heart 
should be rubbed with the blue ointment, which is better for 
this purpose than the oleate. 



110 NOTES ON MATERIA MEDICA. 

2. The ointment of the red iodide of mercury is highly effica- 
cious in the treatment of pachymeningitis of the brain and 
spinal cord, and thus holds an important place in therapeutics, 
because there are very few remedial measures against this most 
serious trouble, which very often causes epilepsy, tonic spasms, 
paralysis, etc. In epilepsy with twitching of the face and ex- 
tremities during sleep, which indicate a cranial cause, viz., 
chronic meningitis, the ointment of the red iodide should be 
rubbed into the skull and nape of the neck. In cases of sun- 
stroke, meningitis following typhoid fever, pressure from in- 
flammatory exudation, and adhesions upon the train and spinal 
cord, apply the ointment of the biniodide to the skull, the nape 
of the neck, and down the spine. On account of its irritating 
properties, it should be applied during the daytime, so as to 
avoid disturbing sleep. It is also a good counter-irritant. It is 
also used in the treatment of enlarged thyroid gland, or goitre. 
This disease is endemic where the water is highly charged with 
magnesium salts. The ointment of the red iodide should be 
rubbed over the surface of the tumor and the patient exposed to 
the direct rays of the sun. One or two applications, al: hough 
sometimes leading to vesication, have been sufficient in many 
cases to cause disappearance of the enlargement. 

The metallic preparations of mercury are: Pilulse Hydrargyri, 
or blue pill; Unguentum Hydrargyri, or blue ointment; Hydrar- 
gyrum cum Creta, or mercury with chalk. 

The chlorides of mercury are two in number: The bichloride, 
or corrosive sublimate (dose, gr. 3V-2V) \ ^ s uses nave already 
been enumerated The subchloride, or calomel (dose, as an al- 
terative, gr. 3L— i.; as a cathartic, gr. v.-x.). 

Black wash (calomel, 3i.; lime-water, Oi.) is a very useful 
application to syphilitic skin eruptions. It can also be used to 
great advantage in many cases of skin disease of an indolent 
character with scaly surfaces; also in pruritus pudendal, and in 
affections generally of the skin and mucous membranes accom- 
panied by pruritus. 

Yellow wash (corrosive sublimate, gr. xxx. ; lime-water, Oi.). 
This lotion is very much more stimulating than the black wash, 
and has been used successfully in the treatment of syphilitic 



MEDICIXAL REMEDIES. Ill 

eruptions, condylomata, etc.; it can also be tried in pruritic 
affections of the skin that do not yield to other treatment. 

The iodides of mercury are two in number : The biniodide or 
the red iodide (dose, gr. fa-fa). The green iodide or the pro- 
toiodide (dose, gr. i~}). This preparation is inferior to calomel 
in the treatment of syphilis. 

The ointments of mercury are as follows: 

Unguentum hydrargyri iodidi rubri, or the ointment of the 
red iodide of mercury. 

Unguentum hydrargyri nitratis, or citrine ointment. 

Unguentum hydrargyri, simple mercurial or blue ointment. 

Unguentum hydrargyri ammoniati, or ointment of the white 
precipitate. 

The oleates of mercury are made by a solution of the yellow 
oxide of mercury in oleic acid. 

According to the strength of this solution will be its activity. 
A twenty-per-cent oleate is very irritating. The five-per-cent 
oleate is usually employed at first, and if no irritation occurs, 
then the ten-per-cent can be tried. 

Summary of the Uses oe Mercury. 

1. As an antisyphilitic. 

2. Against non-suppurative inflammations. 

3. As a functional medicine. Certain preparations of mer- 
cury act as symptom medicines when given in one large dose. 

4. As an external remedy, wiien fibrous induration of a part 
results from chronic inflammation; in diseases of the skin due 
to animal or vegetable parasites. 

II. Iodine (Iodum). 

Iodine is an elementary body obtained chiefly from sea weed. 
Its use as an elementary body in medicine is extremely limited, 
it being used more often in the form of a salt, i.e., iodide of 
potassium, etc. 

It is a specific, and although the least injurious of all the spe- 
cifics, j^et when taken in excess acts as a poison, and gives rise 



112 NOTES ON MATERIA MEDIC A. 

to a train of symptoms known as "iodism." These phenomena 
are coryza with frontal headache, more or less suffusion of the 
eyes, constriction in the throat, and sometimes salivation, gastric 
uneasiness, and consequent loss of appetite. If its use is con- 
tinued still further, there will appear an eruption about the eyes 
and face, nervousness, debility, and even atrophy of mammae 
and testes. 

If the exhibition of iodide of potassium is continued too long 
and in excessive doses, gangrenous sores are apt to be formed. 
They first appear generally upon the legs as blisters on a red- 
dish base; when the vesicle ruptures, it reveals a gangrenous 
floor, which has a tendency to extend very rapidly. As soon 
as this is noticed, the use of the iodide must be stopped and 
quinine and opium given; if no fever is present, the muriate 
tincture of iron may also be given. Some persons are unable 
to use iodine in any form, small doses affecting them very dis- 
agreeably. 

When such idiosyncrasy exists, the exhibition of iodine is 
likely to do more harm than good. 

Uses of Iodine. 

1. In scrofula : Iodine was early used in the treatment of 
scrofula in the form of Lugol's solution (iodine, 3 vi. ; iodide 
of potassium, § iss. ; water, Oi.). This is the best way of ad- 
ministering iodine in all scrofulous conditions. The patient 
should be kept under treatment for a longtime. The dose should 
not exceed six drops four times a day, given immediately after 
meals, as it is quite irritant when taken on an empty stomach; 
it should be well diluted with water. Its chief power lies in 
arresting mucous catarrhs, inflammation and ulceration of 
cartilaginous structures, and in hastening the resolution of 
adenitis and enlargement of lymphatics which follow disorders 
of mucous membranes in advanced stages of scrofula. These 
enlarged glands are usually in the neck, but in strumous girls it 
is not uncommon to find buboes in the groin, due to vaginitis 
and leucorrhceal discharges. 



MEDICLNAL REMEDIES. 113 

In all these conditions the solution of iodine should be given 
in conjunction with cod-liver oil. 

The syrup of the iodide of iron and pills of the iodide of iron 
(Blancard's pills) can also be given; the latter are very good in 
conditions of anaemia. 

2. In syphilis, secondary and tertiary, when the disease begins 
to attack the fibrous tissue, bones, and neuroglia and mem- 
branes of the brain and spinal cord, iodide of potassium should 
be given; and if the patient has not had a thorough course of 
mercurials, small doses of corrosive sublimate should be given 
with it. 

For the cure of syphilitic periostitis and the removal of 
nodes, no remedy is so reliable as the iodide of potassium, but 
it should be given in combination with an opiate, in order to 
relieve the pain, and, although the action of the neurotic is 
transient and purely functional, to assist and hasten the opera- 
tion of the specific, by relieving the symptoms, against the cause 
of which the disease medicine is directed. It is the iodide of 
potassium which removes a node, but when the pain caused by 
that node is removed by the opiate, the specific will act quicker 
and more certainly. 

In the use of iodide of potassium in syphilis, the rule is that 
the more chronic the disease the larger the dose, and the more 
acute the attack the smaller the dose, as such patients are apt 
to be intolerant of the drug. In the treatment of syphilitic 
periostitis, ten grains of potassium iodide, in combination with 
ten drops of the tincture of opium and ten to fourteen drops of 
the fluid extract of conium, should be given every four hours. 
Syphilitic periostitis may occur in the latter stages of syphilis, 
and then the original doses of potassium iodide will not be 
enough, the absorption of inflammatory exudation being slower 
from interference with the collateral circulation. 

Still more serious in every respect is the exudation when it oc- 
curs deeper yet, viz., within the cerebro-spinal canal. Upon the 
development of syphilitic meningitis, syphilitic gummat 'a with- 
in the cranium or spinal cord, and in all cases of syphilitic 
nervous disease, together with syphilitic endarteritis, ten-grain 
doses of potassium iodide have little or no effect. 
8 



■114 KOTES OX MATERIA MEDIC A. 

The drug should be carried up to the point of toleration as 
quickly as in the treatment by mercury. Patients in this con- 
dition can take sixty to eighty grains at a dose where formerly 
ten to fifteen were sufficient. 

In all of those cases of chronic syphilitic disease threatening 
the patient with serious results on account of its location, use 
potassium iodide in heroic doses. Hence begin with twenty 
grains, then thirty, and rapidly increase the dose, watching its 
effects meanwhile. 

It should be always remembered that as it is a disease 
or organic medicine, and therefore unnatural to the system, 
its prolonged use in these doses will produce its poisonous effects,; 
always, therefore, give cod-liver oil and iron; if this is not well 
borne, quinine should be given, together with as much food as 
the patient can possibly take. 

3. In chronic asthma and bronchitis, and in that form of spas- 
modic asthma which alternates with skin disease, or which, 
occurring in an adult, takes the place, as it were, of what would 
have been strumous complaints during childhood, iodide of 
potassium is very useful. 

The potassium iodide does not relieve an attack, but it dimin- 
ishes steadily the tendency to asthma in a very large proportion 
of cases not only of acquired but of hereditary asthma. 

The patient should be kept under the influence of the drug 
for a long time. Four grains of the iodide of potassium, and small 
doses of Fowler's solution (from two to four drops), and ten 
drops of the tincture of belladonna, with a teaspoonful of Hoff- 
mann's anodyne cr the compound spirits of ether, should be 
given four times per clay, largely diluted with water. 

In those cases where asthma is very pronounced and allied 
with bronchitis, the treatment should sometimes be varied by 
giving some other preparation of iodine, and the best for this 
purpose is the syrup of hydnodic acid, one teas]30onfuI corre- 
sponding to four or five grains of the iodide of potassium. 

It is not known how the iodide of potassium acts in curing 
asthma, except that in a very large proportion of cases it is 
found that patients when young have had symptoms of scrofula, 
sore throat, running from the nose and ears. A discharge from 



MEDICINAL REMEDIES. 115 

the nose leads to nasal catarrh, and this leads to thickening and 
hypertrophy of mucous membranes and submucous tissue in this 
part of the respiratory tract. Now, it is an important rule that 
derangement of any exit of canal or tube always reacts upon the 
nervous supply of that tract, and frequently back of it. This 
persistent obstruction in the respiratory tract very often leads to 
disorders of the mechanism of respiration, and hence asthma is 
acquired. Specialists have demonstrated this in many cases. 
As we have said, asthmatic patients in childhood were scrofulous, 
and hence the nasal catarrh may have developed the asthma, so 
that the manner in which potassium iodide acts in asthma is. 
probably that it finds an old scrofulous tendency to deal with. 

The great danger in chronic bronchitis is that the air vesi- 
cles become very much enlarged, lose their elasticity, and ulti- 
mately become nothing but passive bladders; the blood-vessels 
become atrophied, and therefore the right side of the heart en- 
larged, with consequent congestion of the liver, kidneys, etc. 
Emphysema can be prevented, and, when moderate in degree, 
can be recovered from, by withdrawing the obstacle in the bron- 
chial tubes. The only remedy that is a true one, and not a mere 
palliative, is the iodide of potassium and the syrup of hydriodic 
acid, to be given in the same way as in the treatment of asthma, 
the two diseases being almost inseparable. 

4. Iodine is useful in promoting the resolution of exudative 
inflammation, particularly in fibrous tissue. Unfortunately it 
is not so efficacious in periosteal and fibrous tissue due to other 
than syphilitic origin. It should be tried, however, in rheu- 
matic periostitis, but the results are not always certain. 

On the other hand, there are a few conditions where iodine 
can be used, as in tumor of the brain, where there is violent 
and continued headache and other indications of intercranial 
pressure, notably where symptoms are not febrile but due to a 
neoplasm. The administration of large doses of potassium 
iodide seems to moderate the symptoms. 

It is a question whether the preparations of iodine have any 
power over diseases of the arteries. Endarteritis is one of 
the commonest causes of decline of health, and finally of 
chronic disease of the system, indicated by high arterial ten- 



116 NOTES ON MATERIA MEDICA. 

sion and an increase of connective tissue at the expense of higher 
tissues Mention has already been made of the use of corrosive 
sublimate in this condition, but in some cases the tincture of 
iodine (not potassium iodide) seems to act equally as well, and 
markedly so in those cases of chronic BrigM's disease with 
transient albuminuria, low specific gravity of the urine, absence 
of color, etc. The tincture of iodine, in five to ten drop doses, 
well diluted in water, after meals, should be given, and many 
cases respond well to it. 

5. The iodide of potassium is the only medicine that has any 
kind of testimony in its favor in the treatment of thoracic aneu- 
rism, or in the treatment of all internal aneurisms that cannot 
be reached by surgical means. The only recoveries (not surgi- 
cal) have been when large doses of the potassium iodide have 
been given. Internal aneurisms of this class produce certain 
symptoms, due to their pressure upon adjoining nervous tissues, 
causing aphonia and disturbance of the larynx, characterized by 
cough and a peculiar croupy breathing. In all cases of this 
kind the iodide of potassium should be given, and frequently 
after a time the cough declines and the croupy breathing slowly 
disappears, though much later than the cough. In some cases, 
the aneurism stops dilating and shrinks in bulk, and in a few 
instances disappears altogether. 

In chronic mercurial and lead poisoning, the potassium iodide 
should be given in order to facilitate the elimination of the 
metal. Lead forms a compound with the muscular tissues, 
from which it is with difficulty removed, unless by the aid of 
potassium iodide, which is decomposed in the body to form the 
soluble iodide of lead. Electricity should be used in order to 
restore the contractility of the muscles. 

In acute tubercular meningitis, the only medicine which has 
ever done any good is the iodide of potassium. 

Externally, iodine is used as a caustic and counter-irritant. 

Preparations.— Potassii Iodidum; Liquor Iodi Compositus 
(Lugol's solution); Tinctura Iodi. 



medicinal remedies. . 117 

Summary of the Uses of Iodine. 

1. In scrofula. 

2. In syphilis, secondary and tertiary. 

3. In chronic asthma and bronchitis. 

4. In exudative inflammations occurring in the fibrous tis- 
sue; in rheumatic periostitis; in cerebral tumors, with violent 
and continued headache and no fever; in endarteritis with high 
arterial tension. 

5. In aneurisms of the thoracic or abdominal aorta. 

6. Finally, in chronic mercurial and lead poisoning, also in 
tubercular meningitis. 



III. The Bromides. 

The bromides are recent medicines of this generation, and a 
very important addition to the materia medica, and, excepting 
quinine and opium, are used more largely than any other medi- 
cine. The action of the different bromides is so similar that 
they can be described under one, viz., bromide of potassium. Its 
medicinal power is due to its one action, that of diminishing 
reflex irritability by blunting the sensibility of the afferent nerves 
to all such impressions as would give rise to reflex action, which 
results in a motor phenomenon. If taken in large quantities, 
the bromide of potassium may arrest those reflex actions which 
are necessary to life. The one indication for the use of the 
bromides is exaggerated reflex action, whether it be due to abnor- 
mal irritability of the nervous centres or to the over-sensitive- 
ness of the afferent fibres. In its action it is not as rapid as the 
neurotics, but its effects are much more permanent. 

There are certain diseases which seem to depend on perversion 
of function or loss of equilibrium of nerve centres, aggravated 
and often caused by the persistent impressions conveyed by the 
abnormally sensitive joeripheral afferent nerves, inducing parox- 
ysms of convulsive character taking the form of tonic or 
clonic muscular spasms, with or without emotional disturbance. 
Epilepsy is the most noted example of this form of nervous dis- 
orders, and for the better understanding of the action of potas- 



118 NOTES ON MATERIA MEDICA. 

sium bromide, which is the particular remedy to be used in this 
malady, a description of the disease will now be given. 

Epilepsy is a disease which assumes a variety of forms,, many 
of them unaccompanied by any severe outward systemic dis- 
turbance. But whether the external manifestations be pro- 
nounced or slight, it is always a serious disease, and many of 
the so-called slight attacks are ultimately as damaging in their 
effects as the more violent convulsive forms. 

The most common form of epilepsy, characterized by severe 
convulsions, is that termed epilepsia gravior, or le grand mal. 
The attack often comes on so suddenly as to render the patient 
incapable of having recourse to the most rapid of all the actions 
of the body, viz., the instinctive movements for self -protection. 
Other diseases may be rapid in their development, buD in none 
of them is the suddenness of an attack of epilepsy paralleled, 
and it may safely be said that, with the exception of diseases of 
an accidental nature, such as apoplexy, all diseases very sudden 
in their onset are epileptic. In many cases, there are pre- 
monitions varying in duration from five minutes to several 
hours. The most common of these preliminary sensations are 
termed aurse. They are varied in their nature and occur in all 
parts of the body. Sometimes there will be a peculiar sensation in 
the epigastrium, proceeding towards the brain, vaguely described 
by the patient as a breath of cold air; or there may be a modifi- 
cation of some one of the special senses or of some function 
connected with them. The patient sees curious sights — visual 
aura; or hears unusual sounds — aural aura; or the aura may 
consist of a peculiar taste or smell; or there may be aphasia; or, 
more strangely yet, the aura may be purely intellectual, curious 
ideas passing, through the mind. All of these aurse are a part 
of the epilepsy itself, and not simply the precursors of it. It is 
well to bear this in mind, for in many cases, after the continu- 
ance of the convulsive attacks has been broken by the use of the 
bromides, the occasional visitation of one of these aurae is some- 
times looked upon as an insignificant symptom — an erroneous 
idea, for this is an indication that the disease is still present, 
although in a latent form, and, unless appropriate remedies are 
used, the severe convulsions of the disease will reappear. 



MEDICINAL KEMEDIES. 119 

Patients, therefore, should not be led to expect entire freedom 
from attacks of epilepsy until there have been no manifesta- 
tions of aurae for two years. 

A large number of these attacks commence by the patient 
emitting a dreadful, unearthly cry (caused by a sudden cramp 
of the diaphragm and of the muscles of the larynx), so pecu- 
liarly disagreeable in its nature as to frequently affect the 
domestic animals. This cry, whenever it occurs, is of itself an 
unmistakable sign of the disease. Along with this it is very 
common to have the jaws suddenly clenched, and, owing to its 
getting between the teeth, the tongue is not infrequently bitten. 
This is a valuable diagnostic sign, especially in those cases where 
the patient has attacks during the night of which he is uncon- 
scious, or where he imagines that he has only had a fainting 
fit; for whenever the tongue has been bitten, there has been 
severe convulsive epilepsy. A form of this disease, called the 
Jacksonian, always begins in a certain group of muscles, from 
whence the convulsions develop. There is generally pallor of 
countenance, but on account of the muscles of the neck, from 
their violent contraction, pressing upon the great veins of the 
neck, this is rapidly followed by turgescence. Eespiration for 
the same reason sometimes becomes of a gasping character, 
giving the appearance of strangulation; and the eyes, when 
they are not performing irregular movements, are turned 
upward. Occasionally, in these cases, the sphincter muscles 
are in a state of relaxation — not on account of the violent 
muscular movements, for it sometimes happens in slight attacks 
— and the patient passes urine and faeces, If, therefore, from the 
time he was a child, a patient had not, till recently, suffered from 
nocturnal incontinence of urine, it is quite probable he has epi- 
leptic attacks during the night. 

Gradually, during the course of an attack, the convulsions 
cease, the patient passes into a state of coma with stertorous 
breathing, and finally returns to consciousness with a feeling of 
exhaustion and usually with some expression of surprise. 

So much for the convulsive form, regarded by many as the only 
true form of epilepsy; but unfortunately this malady may occur 
without any convulsions whatever, and, therefore, it is not correct 



120 NOTES ON MATERIA MEDIC A. 

to define it as a convulsive disease. Thus a very common form is 
where there is only a slight pallor of the countenance, the pa- 
tient rarely falls, never suddenly, the other symptoms are all 
slight, and he soon recovers from the attack, a little depressed 
and often with a tendency to excessive micturition. This is called 
epilepsia mitior, or le petit mal; but it is not mild or slight, as its 
name suggests, as, on the whole, it has a more destructive effect 
upon the mental powers than the violently convulsive form. In 
another form of the disease the patient does not lose conscious- 
ness; again in others, instead of falling, he performs many actions 
which seem to imply that he is in command of voluntary move- 
ments. This is so only in a limited sense, for his actions re- 
semble those of a somnambulist. This form is called co-ordinate 
epilepsy. The attacks are very sudden in their onset, and are 
truly epileptic; for attacks of le petit mal and of co-ordinate 
epilepsy frequently alternate with convulsive attacks. Another 
variety is where the patient, after the attack, which may or may 
not have been violently convulsive, is seized with a furious ho- 
micidal mania of which he subsequently remembers nothing. 

The definition of epilepsy may now be considered. It cannot 
be defined as a convulsive disease, for many patients with this 
malady have no convulsions ; nor as a disease in which the pa- 
tients fall, for in some forms they walk about during the seizure; 
nor as a disease characterized by total loss of consciousness, for 
this does not always happen, the patients sometimes going 
through very complicated intellectual processes; nor as a disease 
which abolishes either the motor or sensory powers of the body. 
What, then, is the definition ? Epilepsy is a disease characterized 
by sudden, transient, recurrent loss of function on the part of 
one or more cerebral centres, which loss of function deranges 
other nerve functions dependent upon it or them. 

Some writers, from observing the manner in which the con- 
vulsions of epilepsy radiate, say they are due to over-stimulation 
or over-excitation of the motor centres in the cortex of the 
brain. But they may be explained on quite another principle 
important to understand, for upon its thorough comprehension 
depends the correct treatment of the disease. In these convul- 
sions, we have an illustration of the fact that no nerve centres 



MEDICINAL REMEDIES. 121 

ever act independently. For the beautiful co-ordination of the 
various movements of the body, all the nerve centres are related, 
to each other and made mutually dependent. Normally, all move- 
ments are proofs of regulated discipline, no centre acting before 
the others are ready. The sudden arrest or derangement of the 
function of any one of them disturbs the ordinary interaction 
and suspends or deranges the functions of the others. For il- 
lustration, what happens when a steamship is violently shaken 
from stem to stern on account of the screw having been lifted 
out of the water by a large wave? Has the screw been over- 
stimulated? No. The shaking was caused by the screw being 
withdrawn from the force against which it usually acted. In like 
manner, if the motor impulses are removed from the control of 
the inhibitory centres of the brain, convulsions follow. Or, to 
take another illustration, upon the mutual pressure of the stones 
of an arch depends the integrity of the arch itself. Suddenly 
remove one of the stones upon which the others depend, and 
the whole comes down with a crash. Have these stones been 
stimulated or over-excited? No. So with convulsions. They 
are due, not to over-stimulation of the centres, but, as already 
stated, to disturbance of their ordinary mutual interaction. 

Nervous action, unless originated, by the will, never occurs 
spontaneously, but always depends on some afferent impression 
which elicits it. Epilepsy is consequently invariably due to 
derangement of the nerve centres caused by unaccustomed af- 
ferent impressions being transmitted to them which lead them 
to act irregularly. If the derangement occurs in the motor 
centres, there will be convulsions ; if in the intellectual centres, 
there will be intellectual disturbance but no convulsions; if the 
automatic centres are affected, they will be withdrawn from the 
control of the intellect, and the actions of the patient will then 
resemble those of a somnambulist. It is very dangerous, there- 
fore, to create new impressions in any part of the body, for they 
may occasion epilepsy. For instance, the washing of the thora- 
cic cavity in cases of suppurative pleuritic effusion has given 
rise to epileptic convulsions, in some cases so uncontrollable, 
even by chloroform, as to terminate fatally. The most careful 
autopsies have failed to discover any lesion in the brain, or 



122 XOTES OX MATERIA MEDIC A. 

spinal cord, so these curious cases of epilepsy must be due to 
unaccustomed surface impressions' deranging the nerve centres. 
From what has been said it necessarily follows that in the treat- 
ment of epilepsy careful search should always be made for abnor- 
mal surface impressions, and every effort be made to remove them. 
Often this afferent irritation is from within the cranium itself, 
e.g., meningeal irritation, occasioning twitching of the facial 
muscles, especially during the night, and the attacks invariably 
commencing in the same way. Eemove the cause of the irri- 
tation by trephining. Or the same symptoms may be due to 
malformation of the skull causing adhesions, which should be 
removed by corrosive sublimate. Intestinal or stomachic irri- 
tations are also frequent causes of epilepsy, and so is the rapid 
swallowing of food, the incessant action of the epiglottis irri- 
tating the nerve centres. Wherever the irritation is situated, 
in the nose, eyes, bowels, genito-urinary tract, or elsewhere, it 
must be removed before the disease can be effectually dealt with. 
Treatment of Ejjilepsy. — The greater proportion of the ordi- 
nary movements of the body are excellent illustrations of the 
excito-motor function of the nerve centres. As an example we 
may take the act of winking, which usually is purely reflex. 
This action can be prevented in three ways: (1) by severing the 
branches of the fifth nerve which convey the sensory stimulus 
calling for the act of winking to the nerve centres; (2) by para- 
lyzing or blunting the sensibility of the nerve centres by a neu- 
rotic; (3) by severing the branches of the seventh nerve govern- 
ing the muscles which move the eyelids up and down. Now, the 
bromides have the remarkable property of paralyzing periph- 
eral sensations. A patient, therefore, under the influence of 
these drugs, of which potassium bromide is by far the most im- 
portant, has a peculiarly dull, meaningless stare, because those 
peripheral impressions which lead to reflex action have been 
paralyzed, and therefore the patient does not wink, because no 
stimulus to do so reaches the nerve centres. It is doubtless to 



1 The pleural nerves in a closed cavity never felt the sensation of wash- 
ing. Similar fatal attacks of epileptic convulsions have followed washing 
out the stomach. 



MEDICINAL REMEDIES. 123 

this property that potassium bromide owes its efficacy in the 
treatment of epilepsy, for it paralyzes those peripheral irritations 
leading to the convulsions and other manifestations of this dis- 
ease. But it is as if we were watering a small garden-bed by 
turning a whole river upon it; for, in giving potassium bromide 
to prevent epilepsy, necessarily the greater part of the normal 
reflex excitability of the body is also lessened. If given in 
excess, the patient has no vivacity, he is slow and staggering in 
gait, and his movements generally are sluggish because the brain 
is not receiving the proper stimuli; the memory also is im- 
paired, though the mind is never permanently affected by the 
use of the bromides; the blood is impoverished, and there is a 
tendency to oedema and to hemorrhagic extravasation under 
the skin; an acne-like eruption of very disfiguring pimples 
appears on the forehead and elsewhere. There will also be sali- 
vation. If these symptoms are allowed to continue, the epilepsy 
returns in a more incurable and obstinate form than originally. 
But this need not happen, for if given carefully the bromides 
may be continuously administered for three or four years to 
stave off the attacks of epilepsy, without causing any permanent 
injury to the patient's health. As concentrated solutions of 
potassium bromide are very irritating to the stomach and apt to 
cause gastritis, with consequent disturbance of appetite, which 
is by all means to be avoided in this disease, the drug should 
always be freely diluted with water, and the stomach should 
contain sufficient food to cause a flow of the secretions. A little 
milk may therefore be given with the bromide. Cod-liver oil 
should always be given, as it is the great preventive of the 
injurious effects of the bromide, and with it some p eparation 
of phosphorus, e.g., syrup of hypophosphites acidulated with 
phosphoric acid. This is an excellent adjuvant, especially for 
preventing the acne. (Where this last symptom is severe, give 
at the same time small doses of Fowler's solution, and, to free 
the secretions of the sebaceous glands, have the skin well washed 
with tar soap and warm water. ) Moreover, as the action of every 
constitutional medicine is assisted by combining with it a symp- 
tom medicine, neurotics which deal exclusively with symptoms 
of disease may be administered, as for a short time they also are 



121 notes ox materia medica. 

paralyzersof reflex action. The best for this purpose is chloral, 
which has much the same action as the bromides. Another 
adjuvant which may be given is alcohol. As a rule it is not very 
desirable to give this to epileptics, but in certain cases it does a 
great deal of good, especially where, as in nocturnal cases, the 
attack comes on at a particular time in the twenty-four hours, 
If the attacks are always nocturnal, Hoffmann's anodyne may 
also be added. If the attacks occur in the early morning, they 
are caused by the emptiness of the stomach. Give the patient 
food just before the expected attack, and with it administer the 
medicine. This treatment will break up the systemic habit 
engendered by a long continuance of the disease. 

]$Kal. Bromidi, 3 iv. 

Chloral, 3 iss. 

Spts. Frumenti, | iv. 

Aqua?, ad § vi. 

M. 

Dose, tablespoonful t. i. d., in half -tumblerful of water. 
If the patient has nocturnal attacks, give half-dose in forenoon, 
half-dose in afternoon, and double the dose at night; and if the 
attacks are always nocturnal, add 3 i. of Hoffmann's anodyne. 

Potassium bromide is more successful in those cases subject 
to severe convulsive attacks than where this is not the case. 
The great majority of the former class of cases can be cured by 
this remedy properly administered with its adjuvants, but it is 
not so efficacious where the external manifestations of the dis- 
ease are not so pronounced. However, in all cases of epilepsy 
give the bromides in one form or another, and remember that 
the disturbing afferent impression is to be remedied. At the 
same time with the use of bromide of potassium in epilepsy, at- 
tention must be paid to the diet. The pyloric sphincter of the 
stomach is relaxed or semi-paralyzed, and food rapidly passes 
into the small intestines, which are also in a relaxed condition; 
this condition causes the ravenous appetite of the patient, and 
the tendency to "bolt" his food without properly masticating 
it. Animal food aggravates this condition, and should be pro- 
hibited; but if any is taken, it should be in the morning and 
not at night. Fish, milk, and eggs may be allowed. 



MEDICIXAL REMEDIES. 125 

The Bromides in oilier Diseases. — Nervous irritation proceed- 
ing from the pelvic viscera, particularly from the genito-urinary 
tract, produces an extremely depressing effect upon the system, 
the patients having an impression of impending evil. A clean, 
incised wound in the perineum, of only an inch in length, often 
seems to cause more shock to the system than the amputation 
of a limb. Not infrequently, from the extreme depression of 
the heart, there will be cardiac vomiting and uncontrollable 
nausea — a grave sign of speedy dissolution. If any disturbance 
occurs in the pelvic viscera, the abdominal viscera sympathize, 
as shown by the normal function of pregnancy causing nausea 
and vomiting. For all troubles due to pelvic irritation the bro- 
mides are to be given as sedatives, and hence are to be used for 
any nervous condition caused by irritation of the Madder, ute- 
rus, or ovaries, for spermatorrhea, etc., and, as a stimulant ad- 
juvant, alcohol or ammonia should be combined with them. In 
hysteria, hypochondriasis, etc., the bromides may also be given, 
not steadily, but simply to lessen the nervousness. Bromide of 
sodium (dose, gr. xxx.) often answers as well as the bromide of 
potassium (dose, gr. xv. ) for this purpose. Occasionally pel- 
vic disturbances give rise to what gynaecologists term a ute- 
rine cough — a loud, barking, non-expectorant cough, occurring 
whenever the patient is excited. For this trouble bromide of 
ammonium answers very well indeed, as it has an effect on the 
bronchial nerves peculiar to itself, and on this account it is 
also useful in icliooping -cough. 

In tetanus, the spinal cord is in such an irritable condition 
that the smallest irritation, as a puff of cool air or touch to the 
skin, will induce generalized and violent muscular spasm out of 
all proportion to the exciting cause. Bromide of potassium has 
been used in this disease with good results, but its exact value 
has not been determined. 

During the first dentition the irritation which is set up by the 
tooth which is coming through gives rise to reflex pain in the 
ear and to suppression of gastric and intestinal secretions, and 
secondarily to acid vomiting and diarrhoea (due to fermenta- 
tion), and sometimes convulsions. In a majority of cases this 
reflex action is due to the pressure of the tooth on the jawbone,. 



126 NOTES ON MATERIA MEDICA. 

and consequently the lancing of the gums should not be resorted 
to unless there is unusual swelling and tension. Bromide of 
potassium should be given, not to relieve the pain of the tooth, 
but to overcome the reflex irritability, and, by removing the 
cause of the suppression of gastro-intestinal secretions, arrest 
the vomiting and diarrhoea (dose in these cases, gr. v.-vii.). 

In health, there is a physiological association between the 
movements of the stomach and rectum, due to reflex action of 
the muscular coats of one upon the other. Thus, when food is 
taken into the stomach, there is a tendency for the rectum to 
discharge its contents, and, at the same time with the discharge 
of its contents, for the partially digested food to pass through 
the pyloric end of the stomach. 

In chronic dysentery, this reflex action is abnormal. The 
mere taking of a small quantity of food into the stomach causes 
the rectum to act, and the undigested food passes through the 
pyloric end of the stomach and rapidly through the small intes- 
tines, and in the stools there is present the odor of the food. 
This interferes greatly with nutrition, and causes emaciation, 
especially in children. The indication in dysentery is to blunt 
the sensibility of the afferent nerves of the rectum, and so pre- 
vent paralysis of the pyloric end of the stomach. If the stomach 
will not bear the necessarily large doses, it may be given in 
enema per rectum, combined with laudanum. It may be given 
by the mouth, if it does not derange the stomach. 

It is often difficult to make a laryngoscopic examination on 
account of the persistent gagging of the throat, and sometimes 
vomiting, which ensues whenever the uvula or the walls of the 
throat are touched. This reflex action can be overcome by 
administering thirty grains of the bromide half an hour before 
the examination. 

The bromides, by blunting the sensory impressions and thus 
allaying nervous irritability, act indirectly as soporifics; for 
many cases of insomnia are due to irritability of the surface 
nerves from over-fatigue, mental or physical, as in women after 
parturition. Alcohol, ether, and Hoffmann's anodyne greatly 
assist the soporific effect of the bromides. 

Dysmenorrhcea, attended with headache and other disturb- 



MEDICINAL REMEDIES. 127 

ances, is often relieved by the use of the bromides, and by 
placing the feet in hot water. 

Preparations. — The bromides commonly used are those of 
potassium, sodium, ammonium, and lithium. 

The bromide of potassium is the most effective as a reflex 
paralyzer; next, the bromide of lithium; and lastly, that of 
ammonium. 

Fifteen grains of the bromide of potassium will produce the 
same effect as thirty grains of the bromide of sodium or ammo- 
nium. 

The disadvantages of bromide of potassium are that it pro- 
duces bromism much sooner than the other salts; it is more 
depressing on the heart than the bromide of sodium, which can 
be taken for a longer time. 

The bromide of potassium, being taken up by the red blood- 
corpuscles, is apt to cause anaemia when given in excess or for 
too long a time. The bromide of sodium is found only in the 
liquor sanguinis, and is to be preferred in the treatment of deli- 
cate women. In epilepsy, the bromide of potassium acts much 
better than the other salts, and is the only one that should be 
given. 

It should be given in large doses until symptoms of bromism 
appear, and the amount which just falls short of producing 
these symptoms is to be taken as the dose and given three 
times a day. Some patients require forty grains, others sixty, 
others ninety. The last quantity is usually well borne in severe 
cases. Small doses are of no account. 



IT. Arsenic (Arsenium). 

Arsenic ranks among the most virulent of all poisons, being 
very similar in its local and constitutional action to corrosive 
sublimate, and characterized, like the latter, by producing fatty 
degeneration, beginning with the glandular and extending to the 
muscular tissues of the body. Particularly will there be fatty 
degeneration of the liver and kidneys where there is chronic 
arsenical poisoning. These two organs show their degenera- 
tive processes together. It also attacks, by the same morbid 



128 XOTES OTs MATERIA MEDICA. 

process, the peripheral nerves, producing arsenical paralysis. 
The central nervous system, as a rule, is not involved, although 
in many cases the symptoms closely resemble those of central 
paralysis. Mercury and phosphorus also produce fatty degen- 
eration. Phosphorus should not be administered without some 
caution. Its continued administration leads to a form of jaun- 
dice which may become serious, the disease not only being 
functional but textural. Phosphorus should be given with 
more caution than any other of the restoratives. The latter are 
natural to the system, and an excess is merely overfeeding the 
patient; but with phosphorus its natural form is not the same as 
when taken into the system in the food, and it acts in the same 
way as mercury, arsenic, and antimony. All of these medicines, 
in small doses, have a singular effect upon the blood, appar- 
ently increasing the red blood-corpuscles. It is not believed 
that they increase their formation, but prevent their destruc- 
tion and elimination. 

1. As anAntiperiodic. — In pernicious ancemia. there is a steady 
decrease of the red blood-corpuscles. This disease is peculiar 
in its character, and not to be confounded with anaemia of other 
diseases. It has lately been shown that in this disease there is 
a great accumulation of iron in the liver, due to the destruction 
of the red blood-corpuscles, which leave behind them their iron. 
This destruction occurs in the portal circulation, and there- 
fore is not due to changes throughout the system. In perni- 
cious ansamia, no medicine that increases the formation of red 
blood-globules has any effect. Arsenic delays their destruction 
and is effective. It can also be given to prevent the destruction 
of the red blood-corpuscles in malarial disease of the liver, and 
where the. liver is deranged owing to the poisonous effects of 
sewer gas. This resembles malaria, except that there is no de- 
cided periodicity, although there are all the other symptoms of 
malaria. 

Arsenic has long been employed in the treatment of malaria, 
and where quinine fails it ought to be used. 

It operates in an entirely different manner from quinine. The 
latter is generally employed during interfebrile times. Arsenic 
can be administered at all times without reference to when the 



MEDICINAL EEMEDIES. 129 

disease comes and goes, and can be given three or four times a 
day. In the treatment of intermittent fever, it should be given 
up to the point of producing a slight nausea, but should not be 
given too long. 

Fowler's solution (the most definite way of administering 
arsenic) can be given in doses of from six to twelve drops three 
times a day, and in some cases more, with this result: if the pa- 
tient improves, he remains well for a longer time than when 
treated by quinine. No case, however, of ague gets well under 
twenty-eight days; but it can be eradicated apparently better by 
arsenic than by quinine, owing probably to the former being a 
better germicide than the carbolic-acid class. Eelapses in ma- 
larial fever are the exception after having been treated by arse- 
nic. The French army have adopted this treatment for inter- 
mittent fever in certain parts of the sea coast of Algiers. One 
drop of Fowler's solution is given every fifteen minutes, and 
w r hen this produces nausea it is given per rectum. It is 
claimed that this is more successful than the treatment by qui- 
nine. This is probable, as the fever interferes with absorption 
of quinine, the portal circulation being so slow that it has very 
slight absorptive powers, and, as a result, a large quantity of the 
quinine is lost. Arsenic is also used in cases of chronic mala- 
ria, where quinine has been tried without success; notably suc- 
cessful in cases of neuralgia and headaches of malarial origin. 
To be successful it must be given for a long time (three to six 
weeks). When it breaks up the paroxysms of ague, it does not 
do so at once; the patient will keep on having chills, but each 
time they will be less severe, much shorter, no sweating, and so 
gradually decline until there is no fever at all. Quinine, on the 
other hand, to succeed, must totally abolish the paroxysms. If 
they recur, no good can be expected from quinine. 

2. Arsenic is also a great remedy for irritative conditions of the 
stomach, when there is vomiting due to gastritis of a chronic 
kind, as of drunkards, and vomiting due to any obstinate cause 
except a cerebral one. Arsenic may be given in small doses, 
one-half to one drop of Fowler's solution, no more. This works 
like a charm. Also in the vomiting of pregnancy the same doses 
should be used. Sometimes one drop doses of the tincture of 
9 



130 NOTES ON MATERIA MEDICA. 

iodine are equally successful in the treatment of vomiting when 
due to the stomach itself or in pregnancy. 

Arsenic, though difficult to explain how, acts as a specific in 
cjastralgia. Many forms of this complaint are characterized by 
sudden violent attacks of pain, producing deathly faintness, 
without signs of inflammation, gastric ulcer, or peritonitis, 
and will recur periodically once or twice a year. It is due to 
some derangement of the sympathetic system of nerves, similar 
to enteralgia, which attacks the flanks on either side, and evi- 
dently is located in the abdominal plexus. Sometimes there are 
also pains in other parts of the body that raise suspicion of loco- 
motor ataxia, and sometimes they are the premonitory symptoms 
of that disease. For these attacks, arsenic is the remedy. It is 
best given in the form of arsenious acid (dose, gr. ^), in pill 
form with the extract of gentian, repeated every hour. 

3. In Chronic Diseases of the Skin. — Organic or disease medi- 
cines are not beneficial in acute diseases, so arsenic is not to be 
used, as it almost invariably aggravates skin diseases of an acute 
character. The case must have lasted at least six weeks before 
beginning the treatment by arsenic. It must not be given in an 
acute disease, nor in acute exacerbation of a chronic disease. 
Arsenic is the remedy for scaly skin diseases, psoriasis, lepra, etc., 
which are very serious skin diseases and are often hereditary. 
They are relieved by arsenic and one other medicine which should 
always be combined with it — liquor potassaB. It ranks about 
equal to arsenic in chronic skin diseases, particularly scaly ones. 
In the treatment of those diseases, arsenic can be given for 
weeks and weeks, carefully looking out for symptoms, and along 
with it liquor potassas should be given ; sometimes the arsenic 
can be dropped, and reliance wholly placed upon the liquor po- 
tassaB. In these cases, large doses of the liquor potassaB can be 
given, though patients vary remarkably as to the dose they can 
take — as a rule one-half drachm of the liquor potassse and an equal 
amount of the elixir cinchonaB to be taken one hour after each 
meal ; then increase to one drachm, then to a drachm and a half 
and up to two drachms, and some authorities recommend six or 
seven drachms at a dose. It should be diluted with a consider- 
able amount of water. This is a great adjuvant to arsenic, and 



MEDICINAL REMEDIES. 13 L 

particularly good in many forms of skin diseases where arsenic 
does not do good alone, as in eczematous cases. 

4. Along with scaly skin diseases, there will be trouble with 
mucous membranes, as might naturally be expected. In these 
cases, there will be a tendency to asthma and alternate bronchi- 
tis, chronic bronchitis, and chronic emphysema. There are only 
two remedies for this trouble, iodine and arsenic, so that in 
every case of asthma the treatment should be with arsenic and 
iodide of potassium, and give belladonna as an adjuvant. The 
following will be found useful in hay asthma, and should be 
given for two months before the expected attack, which usually 
takes place, in New York City, on August 20th: 

'Sf Liquoris Potassii Arsenitis, 3 vi. 

Tincturae Belladonna, q. s. ad § iij. 

M. Sig. Begin with nine drops in water one hour after 
meals; after a week increase to twelve, after another week to six- 
teen, and after another to twenty, provided there are no symp- 
toms of poisoning by arsenic developing. 

This course of treatment should be commenced about June 1st 
and continue to August and up to the time for development of 
the disease. 

In the first year there will be less of the asthma, in the second 
year very little if any, and the third year is sufficient to break 
up the constitutional tendency to this trouble. Arsenic should 
be given in chronic bronchitis and in cases of ordinary asthma 
in the same way as recommended for slow diseases, with the 
help of a certain class of restoratives to be mentioned later ou. 
Another condition with a tendency to asthma often occurs in 
women, viz., dysmenorrhea, particularly in families subject to 
these scaly skin affections. Arsenic is of great service in dys- 
menorrhcea, inducing a more healthy condition of the mucous 
membrane of the cervix uteri, and in preventing spasmodic 
action and closure of the canal by the mucous membrane. 
Other forms of dysmenorrhcea are not benefited by arsenic. 

5. Chorea is a disease dependent upon the rheumatic poison 
acting in that form in early life, and, like rheumatism, gets 
well of its own accord. This is a serious complaint, having a 
tendency to produce heart disease, and leaving behind it weak- 



132 NOTES ON" MATERIA MEDICA. 

ness of the nervous system. Arsenic should be given i:i full 
doses, children being able to bear it better than adults. 

In eczematous diseases of the shin, arsenic is good, but not so 
markedly as in scaly affections. In papillary diseases, as acne, 
arsenic is quite inferior in its effects to those produced in the 
other two classes of skin diseases already named. Nevertheless 
it is still used in the common form of acne, where the small 
papules are not much inflamed, but should not be used where 
there is inflammation and a tendency to the formation of 
small boils, local treatment being better here. This disease, in 
some cases, is very disfiguring. There is a very close relation 
between acne and irritation of the genito-urinary tract, there- 
fore hot-water vaginal injections, with a little borax and pepper- 
mint or menthol, should be used. This acne may also occur in 
young men, not dependent at all upon anything immoral. These 
cases should be treated by passing a cold sound through the 
urethra into the bladder. The sound should be thoroughly dis- 
infected, and passed twice a week. 

Toxicology. — The medicinal and the poisonous doses of arsenic 
differ widely. The first symptom noticed is a sense of weight 
and discomfort in the epigastrium, very much resembling gas- 
tritis, then pronounced nausea; intestinal disturbances, with 
griping, which may or may not be accompanied by slight loose- 
ness of the bowels. After this commence the constitutional 
symptoms, first manifested about the eyelids, which become 
swollen and puffy, and are more or less stiff when closed or 
opened. Then a sense of numbness and tingling, most pro- 
nounced at the tips of the fingers, owing to the beginning of 
fatty degeneration in the peripheral nerves. This may also 
involve the tongue and the lips. Lastly, a sense of faintness. 
The heart begins to beat feebly, and in some cases there are 
attacks of syncope. The medicine must be stopped or the dose 
diminished at the first symptom of gastritis and nausea. When 
numbness and tingling, with swelling of the face, are present, 
the medicine should be given up altogether or the dose greatly 
diminished. Where no symptoms are present, it is quite cer- 
tain that no harm is being done, although continued for several 
weeks or months together. 



MEDICINAL REMEDIES. 133 

The chemical antidotes to arsenic are freshly prepared hy- 
drated sesquioxide of iron and magnesia freshly calcined. 

Preparations. — Acidum Arseniosi (dose, gr. -^""fj)- Liquor 
Potassii Arsenitis, or Fowler's solution (dose, usually about gtt. 
iv.). Liquor Arsenici Hydrochlorici (or the Liquor Acidi Arse- 
niosi); this preparation is very well borne by the stomach (dose, 
gtt.iij.-vi.). Clement's Solution of the Bromide of Arsenic (dose, 
gtt. iij.). 

This last preparation is very powerful, and is recommended 
in the treatment of diabetes. It answers admirably in dimin- 
ishing the sugar, and also gives muscular strength to the patient, 
great weakness being one of the chief symptoms of this disease. 

Summary of the Uses of Arsenic. 

1. As an antiperiodic. 

2. In chronic gastritis and gastralgia. 

3. In chronic skin diseases of a scaly nature, combined with 
liquor potassse. 

4. In asthma, chronic bronchitis, chronic emphysema, and 
hay asthma. 

5. In chorea. 

6. For dysmenorrhea occurring in women who are subject to 
scaly skin diseases, also in acne where there is no tendency to 
inflammation. 

Y. Silver. 

This substance is used in medicine principally in the form of 
the nitrate, the most convenient and best preparation. As it is 
an organic medicine, any disease benefited by it is a serious one. 
It is particularly effective in those nervous disorders dependent 
upon organic disease of some part of the nervous tract, giving 
rise to violent neuralgic pains, which are sooner or later followed 
by local anaesthesia. A typical disease of this kind is locomotor 
ataxia, the most protean of all nervous disorders in its manifes- 
tations. In some cases, it begins in disturbance of the bladder, 
or with violent pains in the bowels or side, more commonly in 
the left side, and referred, perhaps, to the region of the heart; • 



134 NOTES ON MATERIA MEDIC A. 

other patients lose their voices and have a peculiar sensation 
about the larynx from involvement of the laryngeal nerves, 
while others may have nothing else for years but intermittent 
attacks of vomiting and prostration, with perhaps palpitation 
of the heart. The vomitiug induced by this disease may be 
known by the absence of the local symptoms of tenderness, 
tumefaction, sense of heaviness and pain, and by the diminished 
or absent tendon reflex and permanent contraction of the pu- 
pils of the eye. Fulminating pains are also characteristic of 
this disease, indicating that it is organic and leading to sclerotic 
change. Nitrate of silver relieves these pains better than the 
anodynes, and for the time apparently cures the disease. It 
should be given intermittently, as the long-continued use of 
this drug produces a ghastly discoloration of the skin. The 
pains of angina pectoris, probably due to degenerative changes 
in the intercardiac ganglia, are also occasionally relieved by the 
nitrate of silver. Before the introduction of the bromides, it 
was the favorite remedy with many physicians for epilepsy; and 
where this is dependent upon constant organic irritation, it may 
still be given with some benefit, notably in epilepsy accompanied 
by severe headache. A dose of one-quarter grain an hour after 
each meal may safely be given for six weeks, when its use should 
be discontinued for a similar period, or even longer, and then 
given again. This substance is also a very powerful astringent, 
and hence is one of the best remedies in the treatment of chronic 
dysentery. It should be combined for this purpose with a sub- 
stance that does not dissolve readily. 

I£ Argenti Nitratis, gr. \. 

Pulveris Opii, . gr. J. 

Terebinthinae Resinae, gr. ix. 

Bismuthi Carbonatis, gr. ij. 

M. et ft. pil. No. iii. 

(If nitrate of silver cannot be taken, sulphate of copper may 
be substituted.) Its use has also been recommended in pachy- 
meningitis, myelitis, paralysis agitans, and those forms of vaso- 
motor depressions characterized by violent palpitations, frequent 
flushings, and perhaps permanent dilatation of the arteries of 
certain parts, in consequence of derangement of the cardio- 



MEDICINAL REMEDIES. 135 

inhibitory mechanism, and of the centres which control the 
calibre of the arteries. This condition is met with in some 
forms of Graves' disease or exophthalmic goitre,' though it may 
exist independent of thyroid hypertrophy. (For the uses of 
nitrate of silver as a caustic, see p. 268.) 

YI. Zinc. 

This substance, when given as a medicine, is generally admin- 
istered in the form of the oxide. Its use is restricted to nervous 
disorders, particularly to two, chorea and muscular tremors. 
In chorea, the larger the dose the more quick and effective will 
be the result. Small doses are useless. Commence with two- 
grain doses of the oxide in pill form, three times a day, and 
gradually increase until the dose is five grains. If the patient 
can take the latter amount, the chorea will be relieved in a 
week. If no effects are shown, its use may as well be discon- 
tinued. It may be given until there are symptoms of dyspepsia, 
nausea, and the patient has a metallic taste in the mouth. The 
oxide is to be preferred to the sulphate of zinc, as the latter 
gives rise to nausea in doses larger than three grains, while the 
former does not. 

Tremors are of two kinds: (1) those caused by muscular ex- 
haustion, as from carrying loads that are too heavy; (2) those 
due to positive organic mischief in the peripheral nerves or in 
the nerve centres. If the cause is in the nerve centres, as in 
paralysis agitans, exertion of the will can temporarily stop the 
tremors; if the cause is peripheral, exertion of the will increases 
the tremors. Zinc oxide very decidedly diminishes peripheral 
tremors, which most commonly are dependent upon alcoholismus 
or caused by mercurial or arsenical poisoning. It may be given, 
therefore, to counteract the effects of a drunken debauch, as 
shown in tremor of hands, etc. On account of its soporific 
properties it is also a good remedy for the insomnia of delirium 
tremens, and in those cases bordering on it from inability to 
sleep (dose, gr. iij. t. i. d.). It may also be given to relieve 

1 For the palpitation of the heart in this disease, strophanthus should be 
given. 



136 NOTES ON MATERIA MEDICA. 

the depression caused by the withdrawal of alcohol from the 
patient. For this purpose combine with it one-fourth grain of 
extract of belladonna. Lastly, zinc is of use to check excessive 
secretion from bronchial mucous membrane, as in bronchorrhcea, 
chronic bronchitis, phthisis, etc. It should not be given if the 
secretion is purulent, a3 zinc seems to enter into chemical com- 
bination with the pus, giving an excessively foetid odor to the 
breath. It also diminishes the coughing by lessening the sus- 
ceptibility to irritation which causes the cough. Full doses 
should be given three or four times a day. It is not to be 
recommended for whooping-cough. 

YII. Copper. 

Sulphate of copper has been given for the relief of epilepsy, 
but it is doubtful if it has any beneficial effect when so used. 
Occasionally it may be substituted for nitrate of silver in the 
treatment of chronic dysentery, its principal use being as a local 
astringent. ? 

Till. Bismuth. 2 

This substance is not an ingredient of the system, is very in- 
soluble, and its action may be only local, though in its effects it 
appears to be a specific. It is an excellent remedy for intestinal 
fermentation, and is, in this way, a preventive of gastrodynia, 
sick headache, dyspepsia, borborygmus, etc. It controls the diar- 
rhoea of typhoid fever and chronic phthisis (dose, five to thirty 
grains). 

IX. Colchicum (Meadow Saffron). 

Colchicum is the only vegetable substance known which acts 
as an alterative or specific medicine. Its effects are analogous to 
those of mercury, iron, arsenic, and the bromides, and in over- 
doses it causes very disastrous and permanent changes in the 
tissues and nutritive processes of the body; the blood is im- 
poverished and very difficult to restore to its normal condition; 

1 For the astringent uses of copper, see p. 269. 

2 See also Disinfectants, p. 39, and Constipation, p. 225. 



MEDICINAL REMEDIES. 137 

there is fatty degeneration of the liver, ruinous alteration of the 
gastric mucous membranes, and loss of hair, nails, and teeth. 
Hence colchicum may be termed a constitutional poison. 

Colchicum is the specific medicine for gout in all its varied 
manifestations. "Why it is so cannot be explained any more 
than we can tell why mercury is the specific for syphilis, except 
from clinical experience. Gout is a disease dependent upon the 
presence in the blood of uric acid and combinations of this sub- 
stance with different alkalies, such as sodium, etc. The excess 
of urates in the system is probably due to the lack of oxidizing 
power on the part of the liver to convert the whole of the retro- 
grade substances of the body into urea, part being formed instead 
into uric acid, which in excess enters into combination with other 
substances to form urates. It is difficult for the system to elimi- 
nate these insoluble substances, so they circulate in the blood, 
and finally are deposited in those places where the circulation is 
poorest — e.g., around the joints — and cause local irritation. As 
the treatment of this disease is essentially different from that of 
rheumatism, with which gout is sometimes confounded, it is neces- 
sary to thoroughly understand its nature, for the detection of a 
gouty diathesis will throw a flood of light on a multitude of be- 
wildering symptoms otherwise inexplicable. A gouty condition 
does not always show itself in inflammation of the joints. In 
women especially, it may appear in the form of sore eyes, or as 
bronchitis characterized by violent coughing with a non-purulent 
expectoration, or there may be severe attacks of dyspepsia, diar- 
rhoea, or dysentery, or, what is very commonly the case, the pa- 
tient may have violent neuralgic pains about the head and face. 
Moreover, if one manifestation of the disease be made to disap- 
pear, it will frequently show itself in another form. If the patient 
does not suffer from B right's disease, an incompressible pulse will 
generally furnish the clue for the detection of gout. One in- 
fallible sign of a gouty constitution, when found, is the presence 
of little, bead-like deposits in the cartilages of the ears. 

The principal points for the differential diagnosis of acute 
gout and acute rheumatism are as follows: 



138 



XOTES OK MATERIA MEDICA. 



Acute gout. 

1. History of high living or in- 
herited tendency. 

2. The smaller arteries, irritated 
by the circulation in the blood of 
the insoluble poisons causing the 
disease, contract, obstructing the 
course of the blood through the larger 
arteries, and thus give a full, incom- 
pressible pulse. 

3. At the beginning of the disease, 
gout is monoarthritic, usually com- 
mencing in some small joint, as the 
great toe. 

4. Gout does not leave one joint 
when it attacks another. 

5. An inflamed joint is more sen- 
sitive in the transverse diameter than 
elsewhere. (In the elbow joint, the 
olecranon process is also very sensi- 
tive.) 

6. Veins surrounding inflamed 
joint are dilated. 

7. Pressure with finger, pits or de- 
presses the swollen part. 

8. There will frequently be de- 
squamation of the skin after the in- 
flammation has subsided. 



9. There will be tophi in the 
joint for the rest of the patient's life. 



Acute rheumatism. 

1. History of exposure to wet or 
cold. 

2. The poison circulating in the 
system is soluble, causes no irrita- 
tion, and the pulse is therefore com- 
pressible. 



3. Rheumatism is polyarthritic. 



4. Rheumatism usually shifts 
from joint to joint. 

5. The inflammation and sensitive- 
ness extend uniformly over the af- 
fected joint. 



6. Veins surrounding inflamed 
joint are not dilated. 

7. Pressure with finger does not 
pit or depress the swollen part. 

8. There is never any desquama- 
tion of the skin after inflammation 
has subsided (of course excluding 
that due to the application of iodine, 
etc.). 

9. A joint may wholly recover 
from a rheumatic attack. 



The treatment of acute gout is by the administration of col- 
chicum (dose, Tr. Oolchici Kadicis, gtt. xv. S. To be taken 
every three hours). As soon as symptoms of nausea appear, or 
the bowels act as if there was to be a movement, the dose for that 
particular case has been reached. Some persons who are very 
susceptible to the influence of the drug cannot bear more than 
gtt. x.; but usually where the suffering of gout is severe the full 
dose may be given. In those cases where the bowels are already 
loose, laudanum may be combined with a x.-gtt. dose of colchi- 



MEDICINAL REMEDIES. 139 

cum. Some physicians give this combination after nausea has 
been produced by the action of colchicum, but the practice is 
reprehensible; for the heart may be so depressed as to cause 
cardiac vomiting, and considerable gastro-intestinal enteritis 
may result. The only other medicine that can control the pain 
of gout is a nostrum called Laville's Extract. Its formula is 
well known. 

Often this medicine promptly gives relief where colchicum 
fails. In large doses it acts as a purgative, and its good effects 
are lost (dose, 3 i. t. i. d. once in the forenoon, once in the after- 
noon; or equal parts of Laville's Extract and elixir of cinchona 
may be given, dose 3 iss., divided up into three doses for the 
day). 

What has been said of acute gout is also applicable to the 
clironic form. Colchicum or Laville's Extract should be given 
and the diet carefully attended to. Kigidly exclude all wines 
containing a considerable quantity of carbonic acid, such as 
champagne, moselle, etc., and all beers and ales, as these cause 
gout more than anything else. If the patient insists on hav- 
ing alcohol, spirits such as brandy or whiskey may be given, 
but not rum. as this also has a tendency to produce gout. As 
an excess of animal food should not be taken, meat three times 
a day should not be allowed. Most patients are benefited by 
blue pill once a week. 

For the lithsemic condition, the best remedy is benzoate of 
soda, gr. x t. i. d., taken after meals. If there is dyspepsia, a 
small dose of salol may be added (dose, Salol, gr. ij.; Benzoate 
of Soda, gr. viij.; made up into two capsules, to be taken one 
hour after each meal). When there is irritation of the kidneys, 
the patient should take a small quantity of potash salts— citrate 
of potash or bitartrate of potash — changed once in a while to 
phosphate of soda (dose, 3 i. in course of the day in considerable 
quantity of drinking water). Colchicum, however, is the remedy 
to give in all these cases. Whenever symptoms of the disease are 
aggravated, the patient gets depressed in spirits. He may be put 
for a week upon treatment by colchicum with its adjutant, quinine. 
These drugs always go well together; quinine is a great adjuvant 
in chronic cases (gr. J— J of solid ext. of colch. put up with 



140 NOTES ON MATERIA MEDICA. 

gr. ij. of quinine, t. i. d. an hour or two after eating). In some 
chronic cases, it is good to add powdered guaiacum (make up 
into capsule gr. i. quinine, gr. J of ext. colch., andgr. v. of pow- 
dered guaiacum, t. i. d.). No gouty patient ought to lead a 
sedentary life, as they are always better according to the activity 
of respiratory processes. Colchicum is also good for chorea with 
gouty origin. Treat with large doses. As soon as nausea is 
produced, chorea subsides. 

Preparations. — 

Extractum Colchici Radicis, gr. i.— ij. 

Extraction Colchici Radicis fluidum, . . gtt. ij.-viij. 

Vinum Colchici Radicis, . . . . gtt. x- 3 i. 

Extractum Colchici Seminis fluidum, . . gtt. ij.-viij. 

Tinctura Colchici, . 3 ss.-ij. 

Vinum Colchici Seminis, .... 3 ss.-ij. 



MEDICINAL REMEDIES. 141 



CLASS II.— FUNCTIONAL OE SYMPTOM MEDICINES. 

Functional or symptom medicines are those medicines which 
are given for the relief of the symptoms of a disease, or to stimu- 
late or depress some one or more of the bodily functions. 

In dealing with medicines of the restorative class, we have 
seen that the constant repair or nutrition of the body is a slow 
and not immediately perceptible process, and that consequently 
the action of medicines which affect nutrition must also be slow 
and not immediately perceptible. On the other hand, the 
functions of the various organs of the body are either in inces- 
sant activity — e.g., respiration, the function of the lungs; the 
circulation, the function of the heart and blood-vessels — or else 
they respond immediately to appropriate stimuli, e.g., secretion, 
the function of the glands. In precise relation to the rapid 
and perceptible activity of these functions is the rapid and per- 
ceptible action of medicines which affect them. Hence, the 
features that distinguish these two classes of medicines are 
based on indisputable physiological facts, and they are so funda- 
mental that a thorough understanding of them is absolutely 
essential. 

Functional medicines should, therefore, produce immediate 
and perceptible effects, and if they do not it is because the 
functions of the organ cannot be aroused, or the dose is incor- 
rect. Their whole action is secured by one dose — half a dose of 
a cathartic, for instance, fails to produce any characteristic effect, 
and no different effect follows upon repeated doses. Hence 
they are not cumulative (with the possible exception of digitalis, 
which occasionally, for some inexplicable reason, is apparently 
cumulative) and their effect is transient. Thus stramonium 
may invariably relieve the symptom of spasm in asthma for a 
lifetime, but the last dose has no more helped to cure the dis- 
ease than the first one; repeated doses of these medicines only 
repeating the symptoms of the first dose, without adding any 
further effect on the disease or on the symptom. 



142 NOTES ON MATERIA MEDICA. 

These medicines, which, unlike the restoratives, operate in 
health as well as in disease, produce no recognizable structural 
effect upon the various bodily organs, but affect only their 
functions. Ammonia may stimulate the heart's action, and 
aconite depress it, so as to accelerate or slow the circulation 
accordingly, but neither of these agents affects the structure of 
the heart itself. Opium and tobacco leave no traces on the nerve 
tissues, though taken for years for their effects on the nerve 
functions. Even where functional medicines operate with such 
severity as to cause death, as by the suspension of respiration 
by hydrocyanic acid, except the actual presence of the drug 
itself or of some combination into which it has entered, 
no traces whatever are left by them on the tissues of the 
body. 

As functional or symptom medicines do not operate against 
any disorders of nutrition, they cannot be expected to cure dis- 
ease, for disease is a morbid process almost invariably dependent 
upon disturbed or perverted nutrition of the body. The use of 
these medicines is to lessen distress by acting against some form 
of suffering requiring immediate relief, or to deal with some 
complication, in the course of a disease, requiring immediate 
attendance. They are very important on this account in the 
majority of acute diseases, such as inflammations, fevers, etc. 
These diseases, which may occur in the young and healthy, are 
of the nature of accidents, for we have no means of modifying 
them, and expect nature to recover by her own powers of 
repair. We can, however, by the administration of these medi- 
cines, so manage a case of acute disease as to enable the patient 
to go through it with as little pain and distress as possible, and 
to relieve any complications which may arise. If uncomplicated, 
acute diseases are self-limited and terminate, with rare excep- 
tions, within six weeks. 

The dose of all symptom medicines is the quantity which will 
produce the symptoms characteristic of the medicine, and nothing 
less. Thus, while the ordinary dose of opium for an adult is 
one grain, it may require in peritonitis twenty grains before 
a symptom of opium is obtained; if so, the dose is twenty 
grains. 



MEDICINAL REMEDIES. 143 

Functional or symptom medicines are divided into three 
classes: I. Neurotics; II. Eliminatives; III. Astringents. 



Division I. — Neurotics. 

Neurotics are medicines which produce their symptoms by 
affecting one or more of the functions of the nervous system. 
These functions are so numerous, and differ from each other so 
widely/ that no one neurotic ever acts upon the whole nervous 
system. For instance, sensation is divided into many different 
forms ; there are the nerves of special senses, of temperature, 
of muscular sense, and the indefinable sensation of well-being. 
These different sensations of the body — and the same is true of 
the motor system, whose manifestations may be either automatic 
or voluntary — do not resemble each other, and in their disorders 
they are equally distinct. Hence the use of such terms as 
<{ general nervous stimulants " or "general nervous sedatives" 
is incorrect; for if there was a general nervous stimulant, its 
administration would affect every nerve and muscle of the body, 
producing tonic spasm on account of opposing muscles being 
equally affected. The most widely operative neurotics, such as 
opium, are yet quite selective, and affect the functions of only 
a few out of the many nerve centres. 

As they are purely functional remedies, neurotics cannot cure 
real nervous diseases like epilepsy, asthma, etc., as these are 
generally the most constitutional of all diseases. 

The effect of neurotics is usually weakened by repetition, so 
that the doses have to be increased. Yet they promote the ac- 
tion of organic medicines when they relieve special symptoms of 
the disease. Thus opium and conium materially increase the 
efficacy of potassium iodide in syphilitic periostitis when there 
is much pain, and, on the same principle, chloral, by lessening 
reflex excitability, assists the bromides in epilepsy. 

Owing to the variety of the functions of the nervous system 
which they affect, it is difficult to make a definite classification 
of neurotics, but for general purposes they may be divided 
into : 



144 ;n"otes o:n" materia medica. 

(a) Those which are both stimulants and sedatives, commonly 
called narcotics. 

(b) Those which are stimulants only of certain nerve functions. 

(c) Those which are sedatives only of certain nerve functions. 



(a) Narcotics. 

Narcotics, or those neurotics which are both stimulant and se- 
dative, are agents which generally stimulate some nerve func- 
tions, while they simultaneously depress others — for example, 
opium stimulates some of the higher cerebral functions, and also 
the heart, but at the same time blunts sensation and paralyzes 
the alimentary canal — or else these agents first stimulate certain 
nerve functions and afterwards depress the same, but second- 
arily from exhaustion. 

The principal neurotics of this class are : 

1. Opium. 3. Ethers. 

2. Alcohol. 4. Belladonna and its allies. 

5. Cannabis Indica. 



I. Opium. 

Opium is the inspissated juice of the poppy (Papaver somni- 
ferum), which grows in Asia Minor, Western Asia, and India. 
It is the most ancient of all our great medicines, being well 
known from a very early period. The opium we receive here 
comes from Asia Minor, and is the best. The Indian opium is 
inferior to it. The value of opium depends largely on the cli- 
mate, soil, etc., of the country where it grows. In Asia Minor, 
the poppy is cultivated until its capsule grows to about the size 
of an orange. When the petals have fallen, incisions are made, 
and from these exudes a juice which upon drying masses together 
and is then called gum opium. It has all the disadvantages of 
a vegetable product; it cannot be depended upon for uniformity 
in strength. One year the gum opium is very strong ; another, 
the yield is equally good, but the opium is not so strong. 
We judge its quality by the percentage of alkaloids it 



MEDICINAL REMEDIES. 145 

contains. A good variety should contain twelve per cent 
morphine. A great number, however, contain but four per 
cent. 

Opium as a Stimulant. — Opium stimulates the brain in those 
functions related to thought, more particularly those which have 
to deal with the imagination. This is powerfully stimulated by 
opium, and men spend their lives enjoying the pictures pre- 
sented under stimulation. When this takes place, there is con- 
siderable hyperemia, dilatation of the blood-vessels of the head, 
throbbing of the arteries, etc. The eye will be brilliant, the 
pupils contracted, and at the same time the functions of the 
alimentary canal will be held in abeyance. Prolonged thinking 
and digestion do not go well together. Hence the frequency of 
constipation in those who perform much mental work imme- 
diately after eating. 

As a cardiac stimulant : Opium produces a powerful stimulat- 
ing effect upon the heart. If a full dose of opium be taken by a 
strong, healthy man, its action upon the heart may be appreciated 
by careful examination of the pulse, which is characteristic. 
The cardiac elements of an opium pulse are : 1st, strength; 2d, 
slowness; 3d, perfect regularity of rhythm. The arterial ele- 
ments are : 1st, fulness; 2d, compressibility; 3d, moderate 
length. Now, this is precisely the pulse of a strong man in per- 
fect health. Its most distinctive features are its equability and 
its steadiness, both as regards strength of beat and rhythm. It 
is not affected by those circumstances which ordinarily disturb 
the heart's action, as change of position, exercise, and mental 
agitation ; this constitutes the important difference between 
the action of opium and the other cardiac stimulants. Alcohol 
increases the frequency of the beats, and, for a time, their power 
also; digitalis increases the force of the cardiac systole, but it in- 
terferes with the diastole and causes marked irregularity in the 
pulse. Opium has not so much a stimulating as a truly strength- 
ening and sustaining effect upon the heart, which is toned up, 
so to speak, under the influence of the medicine, so as to empty 
itself forcibly and completely at each stroke. 

Opium as a cardiac stimulant is, therefore, indicated in a con- 
dition of shock. 
10 



146 NOTES OIS" MATERIA MEDICA. 

Shock is a sedative impression per se, but differs from other 
sedative impressions in that it is followed by reaction, which 
reaction it produces itself. Every one is familiar with the 
sudden shock produced by a dash of cold water on the face or 
head. The face turns pale because the arteries contract; the heart 
jumps because it has to force the blood through the sudden ob- 
struction caused by the contracted arteries. The death of expert 
swimmers, supposed to be from cramps, is now demonstrated to 
be due to the sudden stoppage of the heart from its inability to 
drive the blood through the arteries, contracted from the uni- 
versal peripheral cold. 

Those with strong muscles, but not strong hearts, usually suc- 
cumb to such impressions, dying instantly. When the heart 
begins to throb on going into the water, great care should be 
exercised, and nobody under the circumstances should go beyond 
his depth. Opium is the remedy for shock, provided collapse is 
not threatened. Shock is a positive nervous impression, and its 
effect is always recovered from, when it is recovered from, by in- 
creased action; that which was suspended comes back again with 
redoubled force, so that it is always felt, viz. , the reaction, pro- 
vided the shock is not enough to exhaust the powers. The cir- 
culation is increased, the arteries are dilated, and the blood is 
driven all over the body with greater rapidity and force than 
before. Hence shock is a positive nervous impression; in itself 
it is very depressing and always sedative, but when recovered 
from there is always a reaction, by which is meant that all the 
vital phenomena first depressed manifest themselves in an in- 
creased degree. Hence we repeatedly use shock as a therapeutic 
measure — cold shower baths, hip baths, etc. — to arouse the sys- 
tem. Occasionally the reaction from shock is injurious, and we 
are more afraid of it than of the original shock, e.g., surgical 
shock, when measures are taken against the reaction to counter- 
act the violent inflammation produced by it. Shock may be so 
severe that it cannot be recovered from and passes into collapse. 
Shock can induce collapse, but collapse can never produce shock. 
The terms are not interchangeable, for the reason that collapse 
is a negative state of exhaustion. Death may take place in this 
state. If the patient recovers, it will be without reaction. 



MEDICINAL REMEDIES. 147 

Collapse, therefore, resembles pure sedative impressions on the 
nervous functions which are never followed by reaction. Seda- 
tive impressions are of two kinds : medicinal, such as the action 
of hydrocyanic acid and aconite ; non-medicinal, such as a 
warm bath, neither of which is followed by reaction. Shock 
may be so severe, as in cases of surgical shock, that it passes 
immediately into collapse without any reaction at all. The vital 
powers are exhausted, and death results by collapse. 

The commonest of all forms of shock are those due to sudden 
serious traumatic injuries, and, on account of the suddenness and 
severity combined, are very apt to pass into fatal collapse at once. 
If this is likely to be the case, opium should never be given, 
for the reason that in condition of shock the heart is contracted 
and remains so, and there will be a corresponding contrac- 
tion of all the arteries. So long, however, as the arteries 
are contracted the patient will not die with symptoms of col- 
lapse. Collapse is characterized by relaxation of the heart, all 
the symptoms indicating that the heart has no power to propel the 
blood through the body. The portal system becomes congested; 
there will be difficulty of breathing, owing to the pulmonary 
congestion present; also suppression of the urine, due to the 
same cause in the kidneys. The surface of the body looks 
shrunken and shrivelled, so that a familiar face may be totally 
unrecognizable. After death, the heart will be in a state of dila- 
tation, and all the organs will be swollen with an accumulation 
of blood. Now, opium causes the heart to fully dilate before its 
stimulant effect can be felt upon the systole, and this very state 
of things is produced. No medicine should be given in this 
condition which relaxes the heart as opium does. In a case of 
surgical shock where there is danger of the patient passing into 
a state of collapse, medicines must be given that increase the 
systole of the heart, such as alcohol, brandy, and ammonia. If 
there is time, i.e., no immediate danger of collapse, in surgical 
shock, then opium is the medicine of medicines; so that in 
many cases it is good practice to give opium with brandy, alco- 
hol, etc., where there is no fear that the patient is going to sink 
too suddenly. Medical shock is produced by all injuries to the 
abdomen and the abdominal viscera, and produces the same 



148 XOTES OX MATERIA MEDICA. 

effects as surgical shock. Thoracic inflammations do not tend 
to produce shock, but the reverse, there being great exaltation of 
spirits, etc., as in phthisis. But disturbing the abdominal vis- 
cera, even functionally, results in depression; the smallest sur- 
gical injury to the abdominal cavity will produce shock. Hence 
in all affections of this kind there is a small, flickering, incom- 
pressible pulse, and generally a weak one, all the way through 
from first to last. This is just the opposite of the opium pulse; 
hence it is that opium is the remedy for 'peritonitis, as only such 
functional remedies can be. Some have supposed that the 
object of giving opium in peritonitis is to confine the bowels; 
but obstinate constipation is a prominent symptom of this dis- 
ease, because the muscular coats of the intestines are com- 
pletely paralyzed for the time being, and opium would be super- 
fluous if there were no other indication for it. 

Neither is opium given merely to relieve the pain, for cases of 
painless peritonitis do occasionally occur which require as much 
opium as any others. Besides, this hypothesis will not account 
for the remarkable tolerance of opium which forms so charac- 
teristic a feature of peritonitis; for in pleurisy, which is also an 
inflammation of a serous membrane, and may be just as pain- 
ful, ordinary doses are all that can be borne, and are quite ade- 
quate to relieve the suffering. 

What does opium do in peritonitis? It does not act as a sed- 
ative, nor to keep the bowels quiet— the disease itself does that. 
Neither is it given to relieve pain. It therefore acts as a 
cardiac stimulant, to prevent the great danger in abdominal in- 
juries, viz., cardiac failure and consequent death. 

Lastly, opium is of use as a stimulant where, without the least 
pain on the part of the patient, he nevertheless is going to die 
quickly from poisoning by gangrene. This poison, when taken 
into the system, is a powerful anodyne. It suspends pain and 
distress almost as well as opium itself does. The patient is 
generally in fair spirits and dies quietly and peacefully. In this 
disease there is deathly pallor, the patient begins to grow cold, 
has a disagreeable perspiration, and, after a little time, faints 
away and dies. This disease tolerates opium, showing that it 
is being used up as a stimulant; hence in this condition large 



MEDICINAL REMEDIES. 149 

doses should be given. There is a shin disease, lately described 
by Mr. Hutchinson, beginning as a blister, in which patients all 
died from gangrene until treated with opium, when they began 
to recover and in some instances were cured. 

The stimulant properties of opium manifest themselves in a 
particular form of stimulation of the intellectual functions, also 
of the heart, and, to speak rather vaguely, though about as near 
as we can express it, of the general vitality of the system. 
Great prostration occurs in the course of gangrene and slough- 
ing inflammation. When sloughing phagedena attacks a soft 
chancre, the patient should be brought as quickly as possible 
under the influence of opium; also in similar conditions not 
specially connected with gangrene. Opium checks the inflam- 
matory processes, and turns them into adhesive rather than 
necrotic forms of inflammation. There is one element in the 
intellectual stimulus which is of peculiar importance and very 
difficult to describe. It comes as near as possible to the con- 
dition of mind to which we apply the term interest. A person 
interested in a piece of work can do a far greater amount of 
actual labor and feel less fatigued than one who does not have 
this interest. A sportsman will walk double the number of 
miles in his pursuit of game that he could under ordinary 
circumstances ; somehow- the muscles do not tire so rapidly. 
We know as a fact that the brain has a great power over 
this vital force, often preventing the system from giving way 
under conditions of great physical strain; and this endurance 
will be proportionate to the development of the brain, as is 
shown by the fact that officers bear fatigue better than common 
soldiers. The mind can supply to the physical frame something 
of the nature of a stimulus antagonistic to waste, and this con- 
dition is remarkably present in the action of opium. A person 
taking a stimulant dose of opium finds himself in a state of 
great mental interest. He does not want to do anything but 
contemplate the mental pictures that in his imagination rapidly 
pass before him, and which he notices with a sense of delicious 
quiet and superiority to all the annoyances of life. He is not 
excited; on the contrary, calm and philosophical. This condi- 
tion is one of the most seductive and irresistible to overcome of 



150 NOTES ON MATERIA MEDICA. 

all desires that can be awakened by any physical substance in 
our constitutions. There are certain articles which when taken 
into the blood produce corresponding mental and emotional 
conditions and changes, so much so as for a while to make new 
beings of us — not better beings, but new ones. Alcohol, for 
instance, transforms the secretive person into a communicative 
one, the dignified into one who shows a contemptible familiarity 
with all, the peaceable man into a pugnacious one, etc. 

There is a marked difference, however, in the action of nar- 
cotics. Opium is just as difficult to resist as alcohol, even more 
so, but the man who has taken opium prefers to be solitary; he 
is company enough for himself; he does not want his visions 
broken in upon. On the other hand, the alcoholic drinker is 
necessarily gregarious; he does not want to be alone, because 
the stimulation is not of the imagination but of the feelings. 
But certain disasters occur to those addicted to any one of these 
physical means of altering their ordinary constitutional temper- 
ament. Opium is more pronounced in its results and more 
ruinous than alcohol. The mind is not injured by opium; very 
few cases of opium-eating lead to insanity. But instead of that 
the will power, that which makes us really what we are, is 
ruined. Our mental and intellectual processes are mechanical; 
our ideas come and go from us without any other than mechan- 
ical origin. There is no doubt whatever that our intellects 
are just as much machines as our hands and feet. Our ideas 
are dependent upon previous impressions made upon us, and we 
are not responsible for them. But man possesses something else 
besides mind; he is something more than an intellectual machine. 
He possesses a high capacity, called the will, which holds 
him responsible for the way in which he allows his mind 
to work. He is not responsible for thoughts which come un- 
bidden to his mind, but he is responsible if he entertains them. 
He has the power to drive away thoughts which he does not 
wish to remain with him, and vice versa. This habit can be 
cultivated by having a governing principle or purpose control- 
ling life, and it is this power of the will which mainly differen- 
tiates man from the lower creatures. Unfortunately opium, 
alcohol, cocaine, chloral, chloroform, and cannabis indica have 



MEDICINAL REMEDIES. 151 

the power, not of altering the mind (even if they do derange the 
mind, it is quickly recovered from), but of producing afar more 
serious and ruinous derangement of the power of the will over 
the mind. The mind is as good as ever, and so is the will, 
but the connection between them is broken. Nothing can be 
more pathetic than the confessions of powerlessness of those 
who have become addicted to these drugs, to free themselves, as 
De Quincey called it, from the accursed chains which bind them. 
Effort after effort maybe made, but fails, until finally the strug- 
gle is given up in hopeless despair, and the man lapses into a 
mere intellectual machine, dreaming away his whole existence, 
a visionary, helpless human being. In the use of alcohol, on 
account of its having to do more with the feeling, etc., than 
with purely intellectual operations, the degradation is most 
evident in the moral sentiments. The drinker laments his fail- 
ing at first and is deeply ashamed, having lost his true self; 
some suffer from this so acutely as to commit suicide. After a 
time this feeling passes away, until all sense of shame is ulti- 
mately gone— the worst of all results of this criminal tampering 
with our frame by addition of that which rums the dominance 
of the will. 

Sedative Actions of Opium. 

There are different sensations and modifications of sensation 
— the sense of temperature, tactile sensation, pressure, localiza- 
tion, pain, etc., each independent of the other. This is so with 
the anodynes. These agents, which allay the sensation of pain, 
are not all alike. Some will allay certain forms more than 
others. Opium is no exception to this rule. 

As an Anodyne. — The pain characteristic of inflammation lo- 
cal rather than radiating, excited or increased by movement or 
pressure on the part, is relieved more by opium than by any 
one medicine acting directly to relieve that pain without blunt- 
ing the whole nervous system, as when ether or chloroform is 
given. Hence the great use of this medicine in diseases with 
acute inflammatory pains. When these pains are in the perios- 
teum, they give rise to a sense of intolerable aching. This is 
one of the characteristics of inflammations, occurring very early 



152 NOTES ON MATERIA MEDICA. 

in meningitis. When the pains are in fibrous tissue and serous 
membranes, they are of a stabbing or boring character, or both. 
In the pain of mucous membranes, there will be a sense of sore- 
ness. In all of these opium gives decided relief. The dose 
for simple inflammatory pain for an adult is about one grain of 
good opium; but when the patient bears larger doses before the 
pam is relieved, there are very likely other elements than mere 
inflammation causing the pain — that is, if the patient has not 
been accustomed to the use of the drug. 

As an Ant % neuralgic. — Neuralgic pains differ from inflamma- 
tory pains in that the part to which the pain is referred is not 
aggravated by movement or pressure, and is apt to radiate, fol- 
lowing the course of the affected nerve. Neuralgic pains are of 
different origin. Some are due to pressure on a nerve, as in 
cases of tumors, cancers, abscesses, etc., which, besides pressing 
upon it, may involve the nerve in its growth or stretch, the nerve 
by its growth. Others are due to the dilatation of a very nar- 
row duct, owing to the presence of a calculus, renal or hepatic. 
These have a special tendency to produce faintness, nausea, or 
vomiting. Lastly, there are pure neuralgic pains very difficult 
to account for. In many cases, they accompany a state of ane- 
mia; in other cases, they accompany a state of poisoning, those 
of malaria being characteristic. In all these different non-inflam- 
matory pains, opium may be used; the effect will not be at 
all proportionate to the dose, as in inflammatory pains, but it 
should be used continuously for a long time. When patients 
get accustomed to it, the dose must be increased, until often 
quite a large amount has to be given. On this account, opium 
should be assisted by other anodynes, on the principle that a com- 
bination of .two or more neurotics, in small doses of each, is more 
powerful than a corresponding large dose of any one of them. 
All neurotics can be made to work together, even when they 
oppose each other, paradoxical as it may seem, but no antago- 
nism of neurotics is of a chemical kind. No neurotic is the anti- 
dote of another in the same way that an acid is the antidote of an 
alkali. Instead of that, the antagonism is an illustration of the 
law that while some of them stimulate certain functions, others 
simultaneously depress them. There are also neurotics which, 



MEDICINAL REMEDIES. 153 

while antagonizing each other on one function, reinforce each 
other on another function — e.g., atropine and morphine. Atro- 
pine stimulates the respiratory centre; the breathing becomes 
more rapid and stronger. Opium has the opposite effect upon 
the respiratory centre, diminishing the frequency of the respira- 
tions; not only this, but partially suspending them, so that there 
is a marked interference with the breathing, Opium destroys life 
very soon by paralyzing respiration. Atropine can be used for 
counteracting this depressing effect. Belladonna and atropine 
are then really antidotes to opium. Opium can also be used as 
an antidote to belladonna poisoning in the first stage. On the 
other hand, opium is a sedative to the sensory system of nerves, 
and so is atropine. Hence in many cases a better anodyne ef- 
fect is secured by combining the two; here the atropine does not 
antagonize the action of opium, but on the contrary assists it. 
Hence no class of medicines ought to be more often combined than 
neurotics, as thereby the injurious effect of large doses of any 
single one of them is avoided. In the case of severe inflammatory 
pain, nothing equals opium, and in these cases it answers very 
well alone. For neuralgic pains, however, opium should not be 
given alone, lest by doing so the foundation is laid for the de- 
velopment of the opium habit. 

As an Antispasmodic. — Opium will relieve spasms of a certain 
kind only, namely, those due to distention of ducts by calculi, 
etc. — the bile duct, the ureters, etc. — notably in cases of gall 
stones and renal calculi. Very intense spasms occur in the pas- 
sage of a stone, which not infrequently arrest its progress, and 
opium is an admirable antispasmodic for this purpose. The 
patient should be brought rapidly under its influence by hypo- 
dermatic injections of morphine, and very often the spasm will 
subside, the tube relax, and the stone pass through. 

As a Soporific. — Opium is a soporific, having a tendency to 
produce sleep, which may not be immediate, however, owing to 
personal idiosyncrasies. With a large number of persons, it has 
uo tendency to produce sleep, so before prescribing it for this 
purpose it is well to ask patients if they have taken it before 
for the same purpose. Some are kept wide awake all night by 
visions, etc. In other cases, especially in women, it sometimes 



154 NOTES ON MATERIA MEDICA. 

produces a distressing sensation and a good deal of nausea as 
well. Usually it is where persons have been kept awake by 
pain that opium acts bast as a soporific, as well as relieving the 
pain. Large doses will produce somnolence, except in special 
cases. The sleep produced is heavy, with slow respiration. 
This means deficient oxygenation of the blood and the accu- 
mulation of carbonic acid gas, on account of the slow expi- 
ration, the patient waking up unrefreshed and with paii\ in his 
head. That this is due to C0 2 poisoning is rendered probable 
by the fact that when opium is given in the daytime, when the 
patient can respire in the open air, etc., it does not produce 
headache. This only occurs after sleep, and is sometimes very 
severe and lasts for a long time, accompanied with a greater or 
less amount of nausea. A remedy that prevents nausea pretty 
well is hydrocyanic acid. 

After great muscular soreness, as after parturition, a dose of 
hydrocyanic acid, morphine, and chloral is very good. 

Another sedative action of opium, and a very important one, 
is its power to paralyze the peristaltic movements of the intes- 
tines, producing a perfectly motionless condition, particularly 
of the upper part. Hence it is of considerable use in allaying 
excessive peristaltic movements occasioned by the presence of 
inflammatory products. Irritation of the bowels results in one 
of two things — first, intense pain and obstinate constipation 
with vomiting, which means enteritis; an inflammation involv- 
ing the entire mucous membrane of the inflamed part, and 
spreading to the other coats, being very likely to end in perito- 
nitis, the pain at first being localized. In this case, opium 
should be given, but with considerable discrimination as to 
whether it sliould be the first thing or not. When it is given, 
it is for the purpose of allaying pain, having more power in this 
tract for this purpose than in any other part of the body to 
allay inflammatory irritation. 

Another and more common form is inflammation leading to 
mucous catarrh. An abundant flow of serum takes place, and, 
if sufficiently diluted, there is nothing but a watery diarrhoea. 
Very frequently this flow simply mixes with the intestinal con- 
tents, producing irritation, then fermentation and excessive irri- 



MEDICINAL REMEDIES. 155 

tation. When this happens, the peristaltic action begins to be 
very mnch increased, and amounts finally to irritation of the 
middle or muscular coats, which produces cramps, and this 
hurries on the offending matter until discharged from the 
bowels in the form of an acrid, burning, irritating discharge, 
indicating that such matter could not remain longer in the 
bowels without causing pain. 

There is this difference between pain dependent upon irrita- 
tion of the mucous membrane and localized enteritis, viz., in 
the former the sense of diffused soreness continues between the 
cramps, and there is a feeling that it is in the stomach at large. 
Opium should be given here for the purpose of allaying irri- 
tation and peristaltic movements, and by so doing check the 
movements of the bowels. 

Another condition of the bowels is that state resulting 
from this irritation, viz., that for some time there remains 
a weak irritability in which there is a great deal of per- 
istaltic movement without pain. Here we have an indi- 
cation of the same kind of weak, nervous irritability that be- 
longs to all mucous membranes when they have been the seat 
of acute inflammation. Here opium does good, because it 
allays the unnecessary irritability, which at first serves a good 
purpose by helping the offending matter to be voided; after- 
wards, however, and especially in children, it keeps up the 
diarrhoea from the remaining irritability after inflammation has 
subsided. In the first form — enteritis — if called to a recent 
case, and you find the patient has attacks dependent on some 
very indigestible material in the stomach, and not due to intus- 
susception, organic stricture, or hernia, opium should not be 
given. Give castor-oil, and, after that has acted, then give 
opium. If, on the other hand, some considerable time has 
elapsed and symptoms are severe, then opium should be given 
at once, for this very often, when the enteritis has lasted for 
twenty-four hours, relieves the constipation. How does it do 
this, since opium itself produces constipation ? By suspending 
the spasmodic stricture of the intestine at the seat of inflamma- 
tion, by causing the pain there to subside; and after the stric- 
ture subsides, the bowels move of their own accord. 



156 :s t otes ois T materia medica. 

Diarrhoea is divided into two kinds • 

1. The diarrhoea due to inflammation of the intestines as the 
result of fermentation in them. 

2. Diarrhoea due to the absorption of ptomaines into the 
blood. This form is totally different from the first, and is the 
choleraic diarrhoea. Its genesis is entirely different from the 
first, and hence should be treated differently. 

The diarrhoea caused by fermentation is brought about by the 
alteration or suspension of the natural secretions, which fulfil 
the double function of being digestive and antiseptic, the latter 
being quite as important as the former. Many diseases are now 
distinctly traceable to this suspension of antiseptic secretions. 
One-half the cases of B right's disease in this country primarily 
take their origin in the intestines. It is now known that one of 
the great functions of the intestinal secretions is to prevent 
materials from being decomposed by fermentation, so that they 
can be properly digested; and hence whenever the secretions are 
absent, not only is the digestion imperfect, but fermentation 
occurs, which varies very much in its results in different parts of 
the intestines. Under certain circumstances there will be fer- 
mentation of starchy materials, producing enteritis and diarrhoea, 
until the starchy elements have been gotten rid of. Many cases 
of chronic diarrhoea are successfully treated by discovering what 
article of diet is particularly difficult for the patient to digest, 
which opium would have failed to cure. Worse than fermenta- 
tion of saccharine matters is fermentation of the oily elements 
of the food, which produces an extremely irritating series of acid 
products. This begins in the stomach itself, and is continued 
to the upper part of the intestines. Patients frequently vomit 
very acrid materials so irritating that it burns the oesophagus, 
the throat, and the mouth, produces tears, and causes the nose to 
run. It is not uncommon for patients to feel as if they had sore 
throat, owing to the intense irritation produced by these acrid 
products. Enteritis will inevitably result. But the worst of all 
is the fermentation of the nitrogenous principles of the food; 
this produces horribly foetid stools, with a special tendency to 
produce irritation of the lower part of the intestines, viz. ; dysen- 
tery. There is a putrid odor in addition to the sour odor, and 



MEDICINAL EEMEDIES. 157 

the dysentery is an effort of nature to expel the offending mate- 
rial. 

The treatment here is to wash the intestines clear of such 
offending material. The discharges will frequently be mixed 
with mucus and pus. No mucous membrane, paradoxical as 
it may seem, should discharge mucus, at least not in any great 
quantity . The very first thing to be done is to get rid of the mucus 
discharged by the irritated or ulcerated mucous membrane, and 
the whole trouble will subside very often as promptly as in the 
case of inflammation of the bladder, where pus may be in the 
urine for months. If the bladder is washed clean twice a day, 
leaving a little material in the bladder to keep the two surfaces 
from rubbing together, rapid improvement takes place at once. 
The principle of this treatment is the same that should govern 
the treatment of chronic dysentery, viz., to wash the inflamed 
parts quite clear; this acts better than any medicine. Chronic 
dysentery is one of the most obstinate diseases, lasting sometimes 
from ten to twenty years. The reason is that some mucus is 
left decomposing over the inflamed surface, which ulcerates, and 
when this happens the case is extremely difficult, because the 
ulcer is every few hours torn open by the action of the bowels, 
and the ulcerated surface smeared oyer with faecal matter. The 
treatment consists of large injections of peppermint water, and 
this is often quite sufficient to cure this complaint without any 
medicine. 

The number of cases of fatal dysentery and diarrhoea would be 
much lessened if they were not treated with opium, because the 
stoppage of the bowels produces fermentation in addition to that 
already going on. The treatment should be to let all the fermenta- 
tive matter out, because it is irritating the mucous membranes 
down to their deepest parts, and the trouble should be corrected at 
its origin by restoring the natural secretions. Usually the liver 
is out of order; the patient is sallow and perhaps has been 
eating indigestible food. The indications are to clean out the 
bowels, then give a good agent for restoring the natural secre- 
tions, and follow this up promptly with antiseptics for the in- 
testines. Do not give opium unless the patient has many 
movements, due to irritability remaining after the former move- 



158 NOTES OX MATERIA MEDIC A. 

ments, when a small dose of opium can be given to allay the 
pain and too frequent movements, but not by any means to lock 
up the secretions. Disinfect the intestines, and the diarrhoea 
will in a great majority of cases stop of its own accord. This 
treatment is to be persisted in from the beginning to the end. 
Opium is the adjuvant, but disinfectants are the special med- 
icines against every form of intestinal catarrh, whether it be 
diarrhoea or dysentery. This is the principle upon which opium 
is to be used in intestinal disturbances. 

Choleraic diarrhoea is quite different from that just described. 
It is different in its symptoms. First, instead of pain preceding 
the movements, with griping action of the intestines, it sets in 
with a painless, watery discharge, with often little odor. The 
patient does not mind the first movements, being, if anything, re- 
lieved by them. In the fermentative form of diarrhoea, the pain 
is for a time relieved by movements, and then comes on again. 
"Not so in choleraic diarrhoea. The first movement is quite 
painless, the second also; but with the third the patient weakens, 
the face turns pale, the pulse is rapid, fails in size and strength, 
and he begins to show the very perilous symptoms of collapse; 
vomiting sets in with purging, and the patient sinks more and 
more. These symptoms are present in cholera morbus, and are 
typical of Asiatic cholera; they are also present in the choleraic 
diarrhoea of infants. In regard to the latter, it is very unfavor- 
able if the child does not cry with the movements. It would be a 
better sign if griping pains were present. Choleraic diarrhoea 
is produced by a poison generated in the intestines by bacteria 
which differ in different countries, but are evidently of the 
same general species. Bacteria infect children more than adults. 
When they appear in adults, it is called cholera morbus. In 
India, they are the source of epidemics of Asiatic cholera, pro- 
ducing a poison which, being absorbed into the system, para- 
lyzes the solar plexus, producing effects similar to that produced 
by extirpation of the solar plexus in animals, viz., profuse 
serous discharge, with shedding of the epithelium of the intes- 
tines in flakes, causing rice-water discharges, and in infants 
cerebral symptoms, they generally dying in convulsions, and on 
post-mortem examination there will be found an effusion into 



MEDICINAL KEMEDIES. 159 

the ventricles of the brain. In these cases never give opium; 
if it is of any use at all, it is to sustain the heart as a stimulant. 
When there is pain, as in some forms of cholera morbus, 
do not rely upon opium so much as upon camphor, which is 
the counteracting, antiseptic, and sustaining agent. It kills 
the bacteria, prevents the poisoning, and besides this it raises 
the power of the heart. 

In chronic disease of the intestines, use opium steadily, for 
the reason that no chronic trouble of the intestines occurs with- 
out producing a weak, irritable condition of the bowels, leading 
to increased peristaltic action. Small doses should be given, 
the object being simply to prevent peristaltic irritability. One- 
quarter of a grain of opium can be given as an adjuvant, a'long 
with other remedies, three or four times a day in choleraic diar- 
rhoea or dysentery; but do not rely upon opium. 

The difference between diarrhoea and dysentery is marked, 
though sometimes the symptoms are mixed, there being diar- 
rhoea and dysentery together; but whichever disease predomi- 
nates, the symptoms will be according to it. Dysentery always 
keeps the pylorus open, so that very little can be kept in the 
stomach; and on this account it is liable to produce starvation, 
as may be seen in little children with this disease, who look al- 
most like skeletons. Dysentery is very apt to come on immedi- 
ately after eating, so that the odor of the food taken into the 
stomach can be detected in the faeces; and it is also effected by 
moving about. It is allayed by lying down, and therefore does 
not occur as often at night as during the day. Besides this, 
there is a sense of tenesmus after an action of the bowels; so 
that instead of being relieved by the movement, the patient feels 
worse, as if he must have another movement. This symptom 
is a plain indication of dysentery. In addition to this, there is 
a discharge of blood which is bright, not dark, indicating that it 
has come from the lower, not the upper, part of the intestines. 

All of these symptoms contrast strongly with those of 
diarrhoea. Diarrhoea most commonly occurs early in the morn- 
ing before the patient's usual time for getting out of bed, 
commencing when he is lying down; during the day there 
are but one or two movements. If it is chronic diarrhoea, 



160 NOTES OK MATERIA MEDICA. 

there are generally pretty profuse movements in the morning. 
Eating does not especially start the diarrhoea, nor does walking. 
The odor of the food cannot be detected in the faeces, as the 
contents of the stomach have been there for a number of hours, 
and so have been changed. It is of great importance to find out 
at what time the movements occur. If early in the morning, 
it is diarrhoea; if during the day, after walking, it is dysentery. 
There is one kind of dysentery, however, that is different, 
viz., malarial dysentery, dependent upon an infection of the 
system by malarial poison — a disease that carries off multitudes 
of Europeans visiting the tropics, and is also common in New 
York City. The symptoms differ on account of this fact, viz., 
that they are constitutional. It is usually ushered in with a 
chill, followed by high fever and intense headache, aching in all 
the bones of the body, and this is followed by profuse discharges 
from the bowels, uniformly mixed with blood. A case beginning 
in this way is one of constitutional infection, of which dysentery is 
one, but only one, of the elements. Large doses of quinine should 
be given immediately, before the dysentery is dealt with at all. 
In neither of these cases should opium be given at the beginning. 

Opium Poisoning. 

This is the commonest form of accidental or intentional 
poisoning that physicians are called upon to deal with. Its 
symptoms are very pronounced, and afford a test for distin- 
guishing the unconsciousness of opium poisoning from that due 
to other causes. And this brings up the different kinds of 
coma. Coma is not infrequently defined as a state of insensibility. 
This is not as clear as it should be, as such a definition would 
include sleep, the syncope of a fainting fit, etc. Coma may be 
defined as a state of insensibility with symptoms of brain pres- 
sure. No form of real coma can exist unless some portion of the 
cerebrum is compressed either directly or indirectly, e.g., the 
venous exudation of serum into the ventricles from a blow on 
the head. The same part or the same nerve centre will not be 
affected in all comas, but nevertheless some part, if not the 
whole, of the contents of the cranium will be in an|unnatural state, 
owing to the altered circulation of the blood. 



MEDICINAL REMEDIES. 1G1 

Syncope is a condition of simple failure of the arterial circula- 
tion of the brain. It may be due to sudden stoppage of the 
propulsion of blood from the heart, leading to immediate insen- 
sibility. This condition may be distinguished by the character 
of the pulse and the state of the Jieart itself; it is a condition 
of profound anaemia. It differs from collapse insomuch that 
in syncope the consciousness is lost, in collapse it is retained. 
The circulation is very much affected in coma, but not in the 
same way as in syncope; therefore syncope cannot answer at all 
to a condition of coma. 

Opium Coma. — In the first stage, the face is swollen, due to a 
stasis of the venous blood of the face, and this gives/ along with 
the heavy, swollen aspect, a dark flush. Along with this there 
will be a symmetrical contraction of the pupils of the eyes, so 
much so as to be likened to a pin's head in many instances; this 
condition of the pupils should at once lead to a strong suspicion 
of opium poisoning. Next the state of the skin should be 
noticed. In opium poisoning, as opium is a powerful diapho- 
retic, the skin will be wet with perspiration, and, owing to 
opium being also a cardiac stimulant, it will not be a cold, 
clammy sweat in the majority of instances, but similar to that 
produced by exercise. The respirations should be carefully 
noticed; they are characteristically affected by opium. They 
are slowed, sometimes falling even to five per minute. An- 
other characteristic of the respirations is that they are very 
deep and stertorous, as if the whole lung was being inflated, 
and a marked pause intervenes before expiration. In the 
first stage, the pulse will be slow, strong, regular, large, and 
quite compressible, and therefore short. Having noticed these 
things, which, if taken together, are quite pathognomonic, en- 
deavor to arouse the patient. In a great majority of cases, this 
can be done, the patient coming back to consciousness for a 
brief period. At once put some question and notice the answer. 
The articulation is good, what he says he pronounces distinctly, 
and the answer is rational, although, from returning uncon- 
sciousness, he may not be able to complete it; all of these 
symptoms together leave very little doubt of opium poison- 
ing. 

11 



162 NOTES OX MATERIA MEDICA. 

Alcoholic Coma. — This is the commonest form of coma. The 
face is flushed, but it is an arterial flush; the pupils are not 
contracted ; the skin may be covered with perspiration as in 
opium poisoning. There is a marked difference in the respira- 
tions in the two cases. In alcoholic coma, instead of being slow 
and deep, they are regular and hurried, and there is quick 
expiration following inspiration. The pulse is very different, 
and by this it can be determined whether this coma is com- 
bined with the preceding one, viz., whether the coma is due to 
both opium and alcohol. The pulse should always be quick and 
strong, unless the patient has been in alcoholic coma for some 
time, when it will be quick but weak. If any attempt is made 
to arouse the patient, he returns to a drunken consciousness. 
His answers are not rational, and the words are not well articu- 
lated, the first effect of drunkenness being to produce thickness 
in utterance; not only that, but he is irritated by interference 
and probably uses profane language. Individuals under the 
influence of opium never swear. 

Urcemic Coma. — This is very characteristic in one particular: 
the pupils are insusceptible to light; they may be contracted, 
but not symmetrically so, or one may be contracted and the 
other dilated, or, as is not uncommon, both may be dilated. 
The respirations are very irregular, sometimes rapid, sometimes 
slow, but, as a rule, there is not the deep inspiration of opium 
poisoning, though occasionally there is stertorous breathing. 
The pulse is very changeable, sometimes being quite rapid, in 
other cases slow, and has a tendency to irregularity and incom- 
pressibility in the majority of cases. If, in addition to the 
incompressible pulse, rigid arteries are present, it is highly pre- 
sumptive that the coma is urasmic in character. As a rule the 
face is pale, but, if not, the hands will be very white. In 
ursemic poisoning, the skin is of a dead white, chalky color. 

Apoplectic Coma. — This sometimes resembles closely the coma 
of opium poisoning. The respirations may be very slow; usually, 
however, they are very irregular, sometimes slow, sometimes 
rapid. The pulse may be very hard or very full, as in opium 
poisoning. The hands should be noticed. In many cases, one 
iand is moving, the other lying motionless at the side of the 



MEDICINAL EEMEDIES. 163 

body. On taking ivp the hand, it will be found that the arm 
behaves in a like manner ; in other words, there is more or less 
paralysis of one or more of the extremities. On examining the 
eye, not infrequently there will be found strabismus. If this is 
the case (when strabismus did not exist before), the diagnosis is 
settled. The pupils may be either contracted or dilated, very 
commonly the latter. 

Finally, there is coma due to concussion of the brain from 
blows on the head, etc. (It is very important to distinguish 
this form, as it is often due to criminal assault.) There is 
something very characteristic in this form of coma, viz., the 
control of the brain over the spinal cord is withdrawn, and con- 
sequently the reflexes of the spinal cord are set free, and hence 
every external impression leads to twitching of the muscles, some- 
times sufficient to produce a movement of the whole limb. 
Hence, wherever there is jactitation it points to some injury of 
this kind to the head, and is very characteristic. 

Lastly, in the coma of apoplexy and concussion of the brain 
the patient cannot be aroused. In the coma of alcohol and 
opium, he can be. In urasmic coma, except in a few cases, the 
patient cannot be aroused. If he does come to consciousness, 
he does so spontaneously, and not because of any efforts made to 
bring him to. 

The second stage of opium poisoning is quite opposite to 
the first. It occurs during the condition of collapse that 
shortly precedes death, and as a rule nothing can be done for it 
except to greatly stimulate with alcohol or, better still, nitro- 
glycerin. This stage has all the symptoms of profound exhaus- 
tion of the respiratory centre and of the heart. Instead of a 
turgid and livid countenance, it is pale; instead of contracted 
pupils, they may be widely dilated; and there will be rapid and 
shallow breathing, extremely feeble and perhaps rapid and very 
compressible pulse. The patient cannot be aroused; but if any 
answer can be elicited, proceed at once to the treatment of the 
second stage. 

Treatment of Opium Poisoning. — The measures applicable to 
the first stage are not at all applicable to the second stage. In 
the first stage, the stomach should be thoroughly washed out, 



164 NOTES ON MATERIA MEDICA. 

either by means of the stomach pump or by the stomach tube; 
this is very important, and many lives can be saved by so doing. 
If it is certain that opium has been taken in the liquid form, as 
laudanum or the solution of morphine, or that the opium has 
. been in the stomach for some time, the patient having been in 
cooia for a number of hours, it is useless to wash out the 
stomach; it is only wasting time. Eecourse must now be had to 
the two great .antidotes. The first by all odds is the tincture of 
belladonna. It should be given in xx.-gtt. doses, repeated every 
twenty minutes, watching carefully meanwhile the respirations 
of the patient. As soon as they are increased to about sixteen, 
cease the administration until the respirations begin to fall again. 
Also watch the pupils of the eyes; as soon as they dilate, even if 
the respirations have not increased, the dose should be given less 
often. Belladonna has been given in these cases in doses that 
would have been poisonous if opium had not been taken, but 
the opium counteracts the belladonna, and conversely. Twenty 
minutes between the doses is long enough to wait, if the symp- 
toms of opium poisoning have not disappeared. Along with 
belladonna, and in no way interfering with its action, is caffeine, 
preferably in the form of strong coffee. This may be adminis- 
tered at the same time that belladonna is given, and all possible 
means should be used to arouse the patient; he should be pre- 
vented from lying down, as this has a tendency to diminish the 
respirations; keep him moving about, and do not give alcoholic 
stimulants, as they are injurious in this stage. Finally, elec- 
tricity should be used; this is of greater value in the second stage, 
but can be given in both, the object being to stimulate the dia- 
phragm, which, with the heart, has a tendency to stop. Place 
one of the poles of a faradic battery at the nape of the neck, 
waiting until the patient has had expiration. As soon as through, 
apply the other pole to the epigastrium, pressing upwards to 
bring it forward upon the chest. The action of electricity can 
sometimes be increased by dashing cold water suddenly upon the 
chest (not upon the face), as stimulation of the surface nerves of 
the chest causes inspiration. 

Do not apply electricity to the nostrils, as this stops inspiration. 
Also place the poles suddenly on different parts of the chest and 



MEDICINAL REMEDIES. 165 

over the region of the heart; a continuous application in one 
place is injurious. 

Occasionally the patient should be laid down flat and artifi- 
cial respiration resorted to. In this case, keep the battery to the 
nape of the neck when the face is turned downwards, and when 
the patient is turned on his back apply again to the epigastrium, 
and so on. In the second stage, or stage of collapse, do not use 
any of the remedies above mentioned except electricity. The 
condition is now one of great exhaustion. As it is impossible 
to keep him walking in this stage, he should be laid down. Use 
cardiac stimulants; brandy and water should be given ad libitum, 
there being no necessity to take into account the effect of large 
doses of alcohol, because cardiac failure is imminent owing to 
the excessive weakness. 

The following prescription should be used : 

]J Tincturse Nucis Vomicae, 3 i. 

Tincturae Strophanthi, 3 ss. 

Caffeinge Citratis, gr. xxx. 

Spiritus Ammonii aromatici, § iss. 

Aquce, . q. s. ad § iij. 

M. 

Dose, two teaspoonfuls every half or every hour, to be given 
in 3 i. of brandy. 

Hypodermatic injections of nitroglycerin should also be given 
at the same time, gr. y-J-g- at each dose. Meat juice extracted 
from beef steak should be given every fifteen minutes; it can also 
be given freely by the rectum, as it is a strong stimulant. The 
only hope is to tide the patient over this deathly collapse. Dry 
heat can also be applied to the feet and epigastrium. 

Preparations. — Gum opium contains two alkaloids that are 
of sufficient importance to mention specially, viz , morphine 
and codeine. It contains other alkaloids and principles of the 
glucoside class, so that opium has therapeutic properties 
not possessed by morphine. In the first place, opium is more 
of a cardiac stimulant than morphine. For a case, therefore, of 
peritonitis, opium is preferable to morphine. The following 
rule is a good one : Where there is a small, irregular, hard pulse 



166 NOTES ON MATERIA MEDICA. 

(as in something of the nature of peritonitis, abdominal inflam- 
mations, gangrene, or in certain skin diseases that end in death 
by producing gangrene), opium as a stimulant should be used 
rather than morphine, which has slight stimulating properties 
only. Morphine, however, has all the other actions of opium, 
viz., anodyne, diuretic, diaphoretic, etc. Very often mistakes 
are made in regard to the administration of this powerful 
poison. Little children should not have opium given them, 
unless with extreme care. Infants scarcely bear opium at all. 
Death has resulted by the administration of one drop of lauda- 
num to a child six months old. One drop of laudanum to a 
child one year of age is a large dose, for the reason that the dis- 
proportionate development of the brain to the rest of the body 
in children renders them peculiarly susceptible to the influence 
of this drug. 

Alkaloids : Morphinae Sulphas (dose, gr. \). 

Codeina (dose, gr. ss.-i.). 
Liquid Preparations of Morphine : 

Liquor Morphinae Sulphatis (U. S.) [Morphinae, gr. i.; Aquae, 

| i.] (dose, a teaspoonful). 
Liquor Morphinae Sulphatis, Magendii [Morphinae, gr. xvi.; 
Aquae, § i.] (dose, tfj, v., equal to one-sixth grain of mor- 
phine). 
Neither of these two solutions of morphine is officinal. 

Preparations of the Crude Drug : 

Pulvis Opii (dose, gr. i.-ij.). Pulvis Ipecacuanhae et Opii, or 
Dover's powder, or the compound powder of Ipecac. Ten 
grains contain Opium, gr. i.; Ipecac, gr, i. ; Sugar of Milk, 
gr. viij. 
Liquid Preparations of the Crude Drug : 

Tinctura Opii, or Laudanum [Opii, gr. xlviij.; Alcohol, § i.]. 
Ten minims are equal to one grain of opium; there are two 
drops to one minim, consequently twenty drops are equal to 
one grain of opium. 

Tinctura Opii Camphorata, or Paregoric (gr. ij - § i). In addi- 
tion to the alcohol, it contains camphor, benzoic acid, oil of 
anise, and glycerin. This preparation is very pleasant to the 
taste, and has the advantage of acting upon the bronchial 
mucous membrane in bronchitis with soreness. It is well 
adapted for children. Ten drops should be the outside dose 
for an infant. 



MEDICINAL REMEDIES. 167 

Opium can be combined with a number of different medicines, 
so as to have actions that opium by itself cannot produce. It can 
be made to act admirably as a diuretic or to promote the action 
of diuretics, notably when the kidneys are irritated or inflamed, 
e.g., as in stone or gravel. In these cases, the camphorated 
tincture should be given with buchu. This will also act well in 
cases of irritability of the urethra and bladder, increasing the 
good effects of buchu and allaying pain and soreness. Opium by 
itself is a diaphoretic. This diaphoretic action is strikingly 
shown by combining it with ipecac to form Dover's powder. 
It is an excellent diaphoretic in many conditions of dry skin with 
considerable pain, e.g., as in inflammations with fever. Dover's 
powder acts very well here, also in conditions where there is a 
hard pulse, dry skin, and restlessness; and if the tincture of 
aconite root be added in doses of from four to five drops, the 
diaphoretic action is promoted, and there is less cardiac disturb- 
ance than when the Dover's powder is given alone. Another very 
good combination in some cases is the extract of colchicum, 
Dover's powder, and aconite. This combination is very good 
for articular pains. 

Magendie's solution is principally used for hypodermatic injec- 
tions, and five drops are equal to one-sixth of a grain of morphine. 
This should be remembered, as many deaths result from the 
careless use of the hypodermatic syringe, frequently fifteen min- 
ims being given. With a patient unaccustomed to morphine, 
begin with five drops, and increase as necessity demands. 

Summary of the Uses of Opium. 

1. As a stimulant, opium acts as a stimulant to the brain, 
the heart, the intellectual functions, and general vitality of the 
system. 

2. As a sedative, opium acts as an anodyne to relieve pain. 

3. It also acts upon the intestines to arrest excessive peristal- 
tic action, and for certain forms of diarrhoea. 

4. As a soporific. 

5. As a diuretic, especially the camphorated tincture com- 
bined with buchu. 

6. As a diaphoretic. 



168 NOTES ON MATEEIA MEDICA. 

II. Alcohol. 

As a medicine, alcohol is a sedative as well as a stimulant, 
and quite as much one as the other. Alcohol, as such, is the 
most complex of all medicines, in the sense of having so many 
preparations. 

As a Cardiac Stimulant. — Its action upon the heart is simi- 
lar to that produced by violent muscular exercise. The pulse is 
rapid, strong, regular, full, compressible, and very short; con- 
sequently the arterial system is dilated, respirations are in- 
creased, and the heart beats with a force and steadiness of 
rhythm resembling that produced by opium, but differing in 
frequency. This is the main medicinal action of alcohol; but 
as, when violent muscular exercise is prolonged, exhaustion 
results, so this rapid action of the heart, produced by constant 
doses of alcohol, finally ends in cardiac weakness. Alcohol 
requires a great deal of discrimination in its administration. 
The following rules should be closely followed: As a cardiac 
stimulant, it should be given where heart failure is impending 
and there is danger of the patient dying from this. The 
radial pulse is not always a good indication of the strength 
of the heart. An incompressible pulse, due to obstruction of 
contracted arter'es, may give the impression of a full, strong 
pulse, whereas the heart may be very weak. The impulse of 
the heart against the chest walls should be carefully watched. If 
it is very perceptible, do not give alcohol; for as the cardiac 
weakness progresses, the impulse diminishes and becomes quite 
feeble. On auscultation, however, it can be determined exactly 
when alcohol should be given. In many cases of fever, only 
one sound can be heard, and the heart is beating 100-120 per 
minute. This is the second sound. The first sound is so weak 
that it cannot be heard; and it is the rule that where only one 
sound is heard, it is the second, the first having diminished or 
almost disappeared. This is always a dangerous condition, 
there being great danger of collapse; for the first sound coin- 
cides with the systole, and in proportion to its feebleness there 
will be weakness in the systolic contraction of the heart. At 
the first it may sound muffled, but as the contractions become 



MEDICINAL KEMEDIES. 169 

more feeble it can only be hoard by a practised ear. On the 
other hand, the second sound is due to relaxation of the heart. 
If it relaxes quickly, the sound is more clear than if gradual, and 
this clearness of the second sound clearly indicates the begin- 
ning of heart failure. Disappearance of the first sound always 
calls for alcohol, and it should be given until the first sound 
returns clear. 

Cardiac failure in acute diseases may come on suddenly, pro- 
ducing syncope; unlimited quantities of brandy and ammonia 
should be given. It may also come on rapidly in high fever, as 
in typhus fever, small-pox, severe cases of measles, and occasion- 
ally in typhoid fever; in these cases, do not begin the administra- 
tion of alcohol too early. It is impossible to forestall the weak- 
ness of the heart. The stimulants must be reserved for the 
time of actual heart failure. Cardiac failure is more likely to 
occur at certain hours than at others, generally after midnight, 
from that period till early morning. It rarely happens between 
8 and 12 a.m., for usually this is the time of highest vitality. It 
is lowest between 2 and 6 a.m. In many cases, therefore, order 
stimulants to be given during the latter part of the night. After 
midnight, it may be necessary to stimulate till 7 a.m. The 
period of access of the fever is about 3 p.m. At first, the pa- 
tient is stimulated by the access, and this, in turn, is followed 
by restlessness and delirium toward the evening, followed 
by exhaustion between 2 and 6 a.m. As feebleness increases, 
begin stimulation before midnight, then in the evening, 
and back through the afternoon. Alcohol should not be 
given right through the twenty-four hours, neither should it be 
given in small doses frequently repeated; this should only be 
done in cases of hemorrhage. It is much better to give § i. of 
whiskey once every three hours than f ij. in three hours dis- 
tributed over the whole time, one good stimulation being better 
to tide the patient over the depression than repeated small 
doses. 

Alcohol is of great value for its stimulating effect upon the 
spirits in conditions of profound nervous prostration. It should 
not be giver unless there are signs of muscular weakness pres- 
ent, trembling, great depression, etc. ; here it will do good. 



170 NOTES OH" MATERIA MEDICA. 

As a Sedative. — Alcohol is one of the most valuable sedatives, 
in the sense that it is a brake upon the too rapid exhaustion and 
waste of the nervous system particularly, and here it does not 
act at all as a stimulant; when it does so, it produces injury. 

The sedative action of alcohol is simultaneous with the stimu- 
lative, and both are felt from the moment it is taken, affecting 
both the sensory and motor nerves, and particularly the nerves 
that are concerned with the muscular balance of the body. All 
the automatic and the quasi-automatic operations of the body 
are carried on and kept in play by a continuous series of un- 
recognized sensations regulating these motor acts of the bod} T , 
e.g., the sensation of the need of breathing, by the pneumogas- 
tric nerve, etc. This sensory mechanism is very much blunted 
by alcohol from the very commencement. In proportion to the 
amount of alcohol taken, the delicacy of the sense of touch is 
lost. The appreciation of form is next lost, and when actually 
drunk it is difficult to perform any of the ordinary operations 
of the body, not because paralysis is present, but on account of 
the muscles not receiving their proper sensory impressions, and 
therefore not being directed with precision; consequently the un- 
steady gait, double vision, etc., very much resembling the symp- 
toms of locomotor ataxia. 

The sedative action of alcohol in blunting the sense of pain 
is also considerable, so that it is an anodyne, and may, on this 
account, be given with opium to increase its effects, and in 
former days this was done to prepare the patient for surgical 
operations. The sedative action of alcohol is of great use in 
those conditions in which the nervous system is wearing out 
from excessive irritability. It is a universal rule that nervous 
debility is accompanied by excessive reflex irritability. Very 
slight external impressions lead to motor disturbances, and this 
is exaggerated in disease, so that in certain conditions it amounts 
to the cause of death, r.s in tetanus, hydrophobia, strychnine 
poisoning, etc., when a slight touch or breath of air will throw 
the patient into terrible convulsions. In conditions of nervous 
exhaustion, when the patient is worn out with nervous and mus- 
cular irritability, alcohol taken in a proper manner has a re- 
markably quieting effect; also in conditions of insomnia follow- 



MEDICIKAL REMEDIES. 171 

ing great muscular exertion, e.g., women after parturition, who, 
in trying to sleep, suddenly start all over; also in women who 
have had the care of large families for years and who are suffering 
from overstrain; and to men who are subjected to overstrain 
alcohol should be given for its sedative effect. This enables the 
patient to endure fatigue, sleep well, and gain strength — not be- 
cause alcohol adds anything to the system, but because it pre- 
vents waste from continual exhaustion. 

Administration. — The urine can be taken as a guide as a 
stated fact in chronic disease; when the urine is of high specific 
gravity, alcohol is always contra-indicated. . There is not a sin- 
gle condition, in health or disease, with urine of high specific 
gravity, in which alcohol does good; it invariably does harm. 
This is difficult to explain, but nevertheless it is an infallible 
rule. Thus, in diabetes mellitus, where the specific gravity of the 
urine runs from 1.025 to 1.050, and a great deal of nervous ex- 
haustion and muscular weakness is present, there is apparently 
every reason why alcohol should be administered. Instead of 
doing good, however, it always does more or less harm, and 
seems to aggravate the disease. So also in all cases of acute dis- 
ease where the specific gravity of the urine is high with high 
color. In cases of rheumatism where there is great depression, 
also in disturbed conditions of the liver, all of these, being ac- 
companied with high specific gravity of the urine, contra-indi- 
cate the use of alcohol. But, on the contrary, when the urine 
is of low specific gravity, every case is benefited by alcohol, even 
in Bright' 's disease when it is taken so as not to irritate the 
kidneys. Therefore in all conditions in which the urine is of 
low specific gravity and of alkaline reaction — these conditions 
indicating the waste of the body being in excess of its nutritive 
power, especially nervous waste, characteristic of persons with 
a great deal of worry and anxiety, or who have subjected them- 
selves to some heavy strain, venereal excesses, or, in fact, any 
heavy drain on the nervous system — alcohol should be given. 
Unfortunately there is no remedy equal to alcohol for this pur- 
pose. Generally, in these cases, the pulse is very compressible. 
If it is incompressible, it indicates Bright's disease. 

Alcohol should always be taken with food, there being then 



172 XOTES OX MATERIA MEDICA. 

no danger of the alcohol habit being acquired. No drunkard is 
a good eater. Food and alcohol are mutually antagonistic, there 
being hardly a case of delirium tremens in which the patient 
had taken a full meal for twelve to fourteen days beforehand. 
Many of the symptoms are really symptoms of the body demand- 
ing food. Every case of delirium tremens should be fed from 
the very beginning with milk, lime water, beef tea, or whatever 
can be taken into the disordered stomach. Every time the 
patient asks for drink, food should be given. Alcohol taken 
upon an empty stomach stops the desire for food and creates the 
desire for drink. 

The only effect that alcohol ever has in promoting digestion 
is that, when taken with food in moderate quantities, it stimu- 
lates the emotions and feelings pleasurably, causing the food to 
digest better. This is to be explained on the principle of asso- 
ciation. For we find that a good spirit and a cheerful frame of 
mind always accompany a good appetite and a healthy digestion, 
while dyspepsia is almost invariably associated with despondency 
and loss of appetite. 

It is for this reason that pleasant associations and surround- 
ings are so conducive to hearty eating and good digestion, while 
a gloomy atmosphere, disagreeable society, or solitude has the 
very opposite effect. Further, upon the principle of this asso- 
ciation between food and the action of alcohol, we can explain 
the fact that craving for spirituous drinks may always be tempo- 
rarily checked by taking food, and so, also, we find that persons 
accustomed to take alcoholic- liquors only with their meals rarely 
become intemperate. Alcohol, as such, should never be given, 
but in the different preparations, of which there are a great 
variet}^ in degrees of concentration, and hence divided into the 
mild and strong — the mild being the wines, the strong the 
spirits. 

"Wines include beers, which are virtually wines. They are all 
fermentative liquors, and on that account form a complex pre- 
scription, as there are other drugs besides alcohol in fermentative 
liquors. Wines contain tartaric acid, phosphates, ethers, and 
in some wines tannin, in others iron, etc. A good bottle of 
claret contains a large dose of the tartrate of iron. 



MEDICINAL REMEDIES. 173 

In beers there is a quantity of nutritive albumen, so that in 
reality there is more nourishment in a pint of porter than in a 
pint of beef tea. There is a vast difference in the strength of 
the different preparations, wines, beers, spirits. Beer, for ex- 
ample, contains scarcely more than 4 per cent, whiskey 58-62 
percent. It is, therefore, impossible for these two drinks to act 
in the same manner. Before the alcohol in lager beer can affect 
the head, the drinker has to imbibe large quantities, which 
should rapidly pass through the system. Whiskey, on the other 
hand, very soon produces intoxication. Alcohol being not only a 
neurotic, but also a chemical, it produces coagulation of albumen 
and fibrin, and therefore concentrated alcohol produces changes 
in the stomach, liver, kidneys, and finally all over the body. 
This could not be done unless concentrated. There is a marked 
difference in diseases resulting from beer and those produced 
by spirits, dependent upon this chemical action interfering with 
the functions of the liver and leading to diseases elsewhere. 

Different Preparations of Spirits. — Spirits are of different 
kinds: brandy, whiskey, rum, gin. Brandy is an alcoholic 
preparation, strength 56$-58$ if properly made. A tablespoon- 
ful is equivalent to a little over two teaspoonfuls of pure spi- 
rits of wine or alcohol. It contains a large amount of tannin, 
and on this account brandy is constipative. Brandy is there- 
fore often given as an astringent. It also acts better than any 
other alcoholic preparation in increasing the appetite. Hence 
it is a favorite addition to prescriptions containing bark or any- 
thing for arousing the appetite. It is preferable to the tinctures 
for this purpose. Brandy has a large variety of ethers, old 
brandy particularly, some of them closely approaching oil of 
wine itself. These give the particular flavor of each brand, de- 
pendent upon the reaction between vegetable products and alco- 
hol in the process of fermentation. In the case of brandy, an 
ether is generated that is particularly good to arrest nausea, and 
it should therefore be given when there is vomiting with hsemate- 
mesis. The smell of the ether sometimes is sufficient to prevent 
the nausea, as vomiting is more often excited through the sense 
of smell than by any other channel. In the vomiting attending 
labor, brandy should be given, and for this purpose it is prefer- 



174 NOTES ON MATERIA MEDICA. 

able to whiskey, gin, or rum. California brandy is about the 
best. 

Wliishey is the most trustworthy of liquors as to strength. 
It is a diuretic, and this action can be counted on pretty well. 
It has all the advantages of alcohol as such, except that against 
nausea, and it is not constipative. 

Gin is still more of a diuretic, from the juniper berries. It is 
also an antispasmodic, on account of the ethers it contains. It 
is much used to relieve spasmodic pains of the genito-urinary 
system, but it increases the pain when due to gravel. Rums are 
made from fermented molasses. Grin, whiskey, or brandy can 
be used with milk as stimulants. 

Wines. — Wines differ in amount of alcohol and saccharine 
principle. When the ferment and saccharine elements are equal, 
the wine is said to be " dry," while when one or the other is in 
excess a sour or sweet wine results. Wines are divided into 
strong and light wines. Strong wines are those which are 
so concentrated as to range from 18^-22$ of alcohol. The 
sweet wines are produced from very saccharine juices of grapes, 
and hence are from the warmer climates. Sherry (Spain) and 
port (Portugal) are types of this class. The malt liquors are 
fermented liquids produced from grains; they are wines. Their 
strength varies: lager beer, 2$-6$ alcohol; English ales, porter, 
and brown stout, 6f -12fo. The light or sour wines are the 
weakest, as clarets, hocks, etc. In these, the percentage of 
alcohol is from six to twelve. The clarets ought to be made 
from black grapes, and the juice of these includes the coloring 
matter and a portion of the extractives from the skins, so that 
they are red. Light hocks are derived from white grapes or 
black ones without the skins. 

Now, as to the choice of the different preparations, when we 
wish to use alcohol as a sedative, there is no rule but one — that 
is, the patient's own experience. With a great many, spirits 
will be much the best; with others, wines; with others, beers. 
If any of these affects the head, alcohol is not indicated at all, 
or not in that particular form. The effect upon the head should 
be the guide. Women, as a rule, cannot take alcohol unless in 
combination. It goes to the head, causing a sensation of heavi- 



MEDICINAL REMEDIES. 175 

ness, etc. This indicates that even a teaspoonful is too much. 
Wines, as found in this country, are very rarely the juice of the 
grape alone and the product of its fermentation. They all con- 
tain brandies or free alcohol, in order to preserve them from 
further fermentation. As has already been said, any free alco- 
hol is very certain to affect the beads of most women and of 
some men, and hence wines containing free alcohol act more as 
drugs than as wines. The royal tokay California wine is to be 
preferred; it can also be given to children. ~No kind of drink 
whatever, whether it be wine, tea, or coffee, should ever repeat, 
i.e., be tasted again, and this should be the answer to questions 
as to whether any particular drink may be taken. So with 
articles of food. 

The difficulty with beers is that when they do not agree they 
irritate the skin, and both wines and beers, w T hen taken for a 
long time, are prone to produce gout. If there is any tendency 
to kidney trouble, as gravel, etc., anything in the form of beers 
or wines should not be prescribed; nor if there is any tendency 
to eczematous troubles, which are frequently dependent upon 
fermentation iri the stomach. 

Acute alcoliolismus occurs generally in those who go on a pro- 
longed spree after a period of abstinence from intoxicating 
liquors. It is a real paroxysmal disease, like epilepsy; the at- 
tacks become more and more frequent, the interval between 
them decreasing. 

Hereditary tendency has a great deal to do with the etiology, 
children of drunkards have a tendency to insanity. The parox- 
ysms occur especially in those who are highly gifted and tal- 
ented. They will drink in secret, and cannot be restrained by 
any influence. When the desire for drink comes on, the appe- 
tite is lost; no remedy can control the craving except veratrum 
viride, which should be given in five-drop doses of the tincture 
until nausea is produced. There is generally great tolerance of 
the drug in these cases. The nausea supplants the thirst better 
than anything else except food, but these patients refuse to take 
the latter. The symptoms of an impending attack are an in- 
creased pulse and high arterial tension. 

When a large amount of alcohol has been taken in a short 



176 NOTES OX MATERIA MEDICA. 

time, acute alcoholic poisoning may result. The symptoms of 
this condition are: coma, relaxation of the entire muscular sys- 
tem; pulse is hard, rapid, and strong. This may develop into 
convulsion, epileptic in character, resembling puerperal eclamp- 
sia. The face becomes blue, the heart very rapid. To save 
the patient, either bleed until the pulse becomes soft and 
patient shows signs of consciousness, or administer tr. veratrum 
viride in drachm doses until the same effect is produced. There 
is no danger of veratrum poisoning. 

Chronic Alcoholic Poisoning. — 1st. Delirium tremens always 
follows prolonged drinking without taking food. It is pro- 
duced by alcohol following starvation, and will not occur unless 
the patient has been without food for ten days or two weeks. 
He should be forced to take food. 

2d. Alcohol Habit : Patients suffering from this habit com- 
plain of gastric troubles. There is loss of appetite, especially 
in the morning; animal food is distasteful; there is pain on 
pressure over the stomach 

The bowels are constipated, and movements are scanty and 
dry. Tongue is brown at the back and dry, with red tip; the 
red line continues on the fauces. There is also chronic pharyn- 
gitis. 

The hands are fat, flabby, and soft. Sleep is disturbed char- 
acteristically; the patients sleep well the first part of the night, 
but wake about 3 A.M., and are unable to sleep again, or, if they 
do, are troubled by unpleasant dreams. 

Constant and excessive use of alcoholic stimulants ages the 
drinker in all respects. He becomes an old man before his 
time; the skin becomes dry, with soft, unhealthy, waxy feeling. 
The mind becomes sluggish and weak. These changes are due 
to a sedative action of a paralytic character. 

III. Ethers. 

Ethers are agents generated by the action of an acid upon 
alcohol. There are a great variety, but those used in medicine 
are few. Used as medicines, they have properties similar to 
those of alcohol, only more rapid and evanescent, but they also 



MEDICINAL REMEDIES. 177 

possess properties distinct from alcohol. Thus sulphuric ether, 
when taken into the stomach, produces a sensation of warmth, 
as alcohol does; along with this, the heart begins to beat rapidly 
and strongly, and its action is still further characterized by 
dilatation of the arterioles all over the body. Hence every one 
of the ethers, taken in sufficient doses, is a decided diuretic, pro- 
ducing warm perspiration. Some of them act upon other 
secretions, notably sulphuric ether, which is a good cholagogue; 
and all of them, but particularly sulphuric ether, are very 
efficient in arresting the spasms of ducts in the intestine, the 
gall bladder, etc. They are the most valuable medicines of the 
neurotic class for this purpose. 

Spirit of Nitrous Ether. 

Sweet spirit of nitre has a special effect upon the kidneys. 
It is more of a diuretic than sulphuric ether; it is also a very 
good agent to relieve spasm of the uneter, and, to a less degree, 
of the bladder and. urethra. Hence it is often given to relieve 
the pain caused by renal irritation, and is of service in condi- 
tions of congestion of the kidneys; besides this, it is an admir- 
able diaphoretic. 

It can also be used in bronchitis with pain and soreness m the 
chest, especially in children. 

Chloric Ether. 

Chloric ether, or spirit of chloroform, is not used very much 
at the present time. It is very good for allaying irritability of 
a sensory kind producing nausea, and so can be given in the 
vomiting of pregnancy, also in intestinal colic; a few drops 
given with glycerin have the same effects as Hoffmann's ano- 
dyne. 

Spiritus ^Etheris Comp. 

The compound spirit of sulphuric ether, or Hoffmann's ano- 
dyne, is a combination of sulphuric ether with alcohol and the 
heavy oil of wine. All ethers are of very low specific gravity 
12 



178 NOTES ON MATERIA MEDICA. 

and very volatile when pure. Alcohol, when added to them, 
lessens their pungency and develops their power. The oil of 
wine is an extremely valuable antispasmodic. This preparation 
is the best of all the ethers for the relief of pain that is paroxys- 
mal in character, due to the spasms of ducts. It can also be 
given for the relief of asthma. 

The oil of wine is very expensive, and on that account in 
some cases is not added; so, also, with the sweet spirit of nitre 
and compound spirit of sulphuric ether. SquibVs preparations 
can be depended upon, however. 

Ethers are of some importance in the treatment of Bright 's 
disease. The nitrates are a class of medicines that have very 
decided effects in relieving or in preventing spasm of the un- 
striped muscular fibres. Arterial spasm is caused by certain 
poisonous products in the blood, and, as a result of this chronic 
contraction, enlargement of the heart takes place, and in the 
kidneys themselves this persistent tonic contraction leads to low 
specific gravity of the urine, clearly indicating that materials 
that ought to be excreted are retained in the blood. In spas- 
modic or irritable stricture of the urethra, great difficulty is 
sometimes experienced in the introduction of a sound; in which 
case, placing the feet in hot water, the administration of a 
full dose of chloric ether, and the injection per rectum of ten 
drops of tincture of aconite in an ounce of warm water, will often 
relax the spasm, so as to admit of the passage of the instru- 
ment or to render the operation unnecessary. The muriated 
tincture of iron contains chloric ether, and may be used in 
urethral spasm. 

Ammonia and ethers combined are used for the relief of 
trigeminal neuralgia, occurring in angemic persons and due to 
feeble circulation. 

The Mydriatics. 

The mydriatics are a class of medicines bearing close resem- 
blance to each other, and take their name from the fact that 
their most characteristic effect is marked dilatation of the pupil. 
The most important members of this class are belladonna, hy- 



MEDICINAL REMEDIES. 179 

oscyamus, and stramonium. These drugs come from one par- 
ticular family of plants called the solanaceae. 

IT. Belladonna. 

Belladonna is the best type of this class. The action of these 
medicines can be explained by their innervation of the rhythm 
of involuntary muscles (voluntary muscles do not act rhythmi- 
cally). The action of involuntary muscles consists in a wave 
beginning at one end, and proceeding in a wave through the 
whole length of the muscle. There is one peculiarity about the 
arrangement of rhythmical muscles — if in a state of spasm, in- 
stead of the whole muscle being affected, one half sometimes 
will be contracted and the other half paralyzed or relaxed. 
In studying their arrangement, when they surround tubes we 
find that some of their fibres run lengthwise and some trans- 
versely; hence when a tube — e.g., the intestine — is in a state 
of spasm, one part will often be contracted, and next to it 
there will be a dilated or relaxed part. Cramps are often present, 
due to the fact that the air passes first into a constricted part 
a,nd then into a dilated part. This alternate contraction and 
relaxation produce various rumbling sounds in the intestines. 
What belladonna and the other members of this class do is to 
act in restoring the normal, vermicular, steady rhythmical ac- 
tion of these muscles. Unstriped muscular fibres are always 
found in the tubular or involuntary muscles, never in the volun- 
tary or skeletal muscles. 

The tubular structures, as the arteries, etc., in large divi- 
sions if not in small ones, have a muscular coat; besides, there 
are a number of hollow viscera which are really dilatations of 
tubular structures, e.g., the stomach, the bladder, and the 
heart. Hence many diseases of the heart we now know to be 
due to the fact that the blood-vessels are affected, which re- 
act upon the heart and hence involve the whole mechanism. 
Therefore, in heart disease it should be remembered that the 
arteries are a part of the same apparatus, and that many affec- 
tions of the heart are dependent on their action. This explains 
the good effect of belladonna in heart disease. Rhythmical 



180 XOTES OX MATERIA MEDICA. 

muscles are to be found lining all the tubes and viscera; bella- 
donna and its allies restore the natural action of the muscular 
layers. 

The bronchial tubes are sometimes affected in their rhythm by 
a purely nervous disease. In asthma, there is a cramp of the 
finer bronchial tubes in the same way as already described — not 
the entire tube, but certain portions of it: one part is contracted 
and the other is dilated or relaxed; hence the air, in passing 
through, gives rise to a musical, sibilant, or whistling sound. 
Belladonna arrests the spasm by restoring the natural rhythm, 
and as soon as this is done the contracted parts relax and the 
dyspnoea disappears. Asthmatic breathing is very different from 
other kinds of dyspnoea which are very often confounded with 
it. There is one unmistakable sign which, if not present, shows 
that the disease is not asthma: that is, difficulty in expiration. 
The air goes into the lungs with comparative ease, but the pa- 
tient cannot drive it out again so readily, in marked distinction 
to normal breathing, in which inspiration is three times as long 
as expiration. In asthma, the conditions are reversed. Bella- 
donna and its allies, for the time being, relieve the spasm ; but 
as they are neurotics, whose functions are to relieve symptoms 
only, they cannot cure the disease. The symptoms are relieved, 
but the asthma itself is not in any way benefited. 

It not infrequently happens that persons of a nervous temper- 
ament are troubled with a choking sensation, as if some foreign 
body were lodged in the oesophagus. This is a real " globus 
hystericus," even when occurring in males, and indicates that 
there is a spasm of the oesophagus. A large quantity of saliva 
collects in the dilated portion during the night, and is raised in 
the morning. Belladonna will relieve this condition, if it is not 
due to serious structural disease. This condition usually ends 
in irregular contraction or cramp of the stomach. In all cases 
of dyspepsia, nervous, irregular action of the he art, palpitation, 
severe stomach-ache, it is an indication that whatever is given 
must contain belladonna. In gastrodynia, it should always be 
tried, not only with tonics, but with bismuth, pepsin, and re- 
sorcin. 

In chronic constipation of women, there is a peculiar tendency,. 



MEDICINAL REMEDIES. 181 

when the ovarian plexus is irritated, to paralyze the peristaltic 
movements of the intestines. In dysmenorrhea or a tendency 
to amenorrhcea, there will be obstinate constipation, due, in a 
great part, to the irregular contraction and spasm of the intes- 
tines. If this condition lasts for any great length of time, dur- 
ing a paroxysm borborygmi will be developed; this is due to a 
running sort of contraction and relaxation of the intestines. 
This reflex nervous disturbance is one of the commonest causes 
of constipation in women, and hence belladonna should always 
be added when a laxative is to be given. 

B Extracti Belladonnse, gr. v. 

Extracti Nucis Vomicae, gr. x. 

Extracti Colocynthidis Comp., . . . . 3 i. 

Liquoris Potassae, gtt. 1. 

M. et ft. pil. No. xx. Sig. One at night. 

On the same principle, belladonna and its allies are of great 
value in the treatment of cystitis. The bladder, when irritated 
or inflamed, acts in a spasmodic way, expelling its contents. The 
principle is to give rest to the part, as every movement aggra- 
vates the inflammation. Belladonna here relieves the spasmodic 
action very markedly, and should therefore be given. If the 
muscular fibres of the bladder have lost their tone, the bladder 
is of course weakened, and belladonna should not be given. 
This is the case with old men, who are often troubled with 
obstruction due to an enlarged prostate gland ; the bladder, 
retaining its contents, loses its power of expulsion, and hence 
must be emptied very frequently, because it is virtually a very 
much smaller one, only the upper part being capable of ex- 
pelling its contents. In this case, if belladonna should be given 
the patient could not empty the bladder at all. Belladonna sim- 
ply allays the spasmodic irritation, and is not a stimulant to the 
bladder itself. Overdistention frequently happens during the 
process of parturition, and is always a serious matter, for it is 
a rule that unstriped muscles, if overdistended or stretched, 
never recover their normal condition again. The patient should 
not go for more than three or four hours after parturition with- 
out micturition. Four women out of five' who have borne ch.il- 



182 XOTES OX MATERIA MEDICA. 

dren have difficulty in emptying the bladder, due to this one 
cause. In these cases, belladonna should not be given, but in- 
stead of it give mix vomica and perhaps add ergot. 

Nocturnal incontinence of urine in children is generally due 
to irritation of the bladder, causing it to expel its contents as 
soon as it has become filled to a certain degree, provided this is 
not prevented by a direct act of the will. Belladonna will often 
effect a perfect cure in these cases, but it must be given in suffi- 
cient quantities to secure its full physiological effect at night. 
It should cause flushing of the child's face while he is awake. 
Combining it with chloral and ergot may be beneficial. 

The Vascular System. — It is of special use in certain affec- 
tions of the heart in young persons who have had rheumatic en- 
docarditis. Very often, in a year or two, there will be dilatation 
of the left chamber of the heart, with severe pain on exertion; 
this is due to want of balance in the rhythm of the two sides of 
the heart. In cases of cardiac pain, confined to the heart itself, 
with rheumatic history, etc., a belladonna plaster can be ap- 
plied and belladonna itself given internally; it can be combined 
with iron and given in pill form. The pain of angina pectoris 
is not confined to the region of the heart, but radiates down 
the left arm ; the latter pain is not relieved by belladonna, but 
by nitroglycerin and other cardiac stimulants. 

Glandular Secretions. — Belladonna arrests certain normal se- 
cretions of the body. It is the most reliable drug to check the 
secretion of milk, and should be given for one or two weeks con- 
tinuously. If, therefore, a woman expects to be confined, and 
knows that she cannot nurse her child, belladonna should be 
administered, before parturition. By some it is claimed to be a 
good remedy for the tediousness of the first stage of labor. Be 
this as it may, it will certainly cause milk to dry up without 
forming abscesses. The internal administration of the drug is 
to be preferred in these cases. However, if promptness is essen- 
tial, apply locally; but poisoning sometimes results from its ap- 
plication to the breast, where the skin is very thin and absorbs 
readily, the constitutional effects of the drug being sometimes 
produced. The officinal ointment is to be preferred. Exces- 
sive sweating in the armpits and the feet may be checked by the 



MEDICINAL REMEDIES. 183 

application of the ointment of belladonna. If, however, it is 
general, as in phthisis, belladonna should be given internally 
in the form of the tincture or the solid extract. 

Preparations. — Tinctura Belladonnae (dose, t\[ x.); Extrac- 
tum Belladonnae (dose, gr. i). 

The alkaloid atropia is very powerful, and is used almost ex- 
clusively for making solutions to dilate the pupil for examina- 
tion of the eye, being superior to belladonna itself for this 
purpose. 

Summary of the Uses of Belladonna. 

1. In bronchial spasm and asthma. 

2. In spasm of the oesophagus, dyspepsia, cardiac palpitation, 
and gastrodynia. 

3. In chronic constipation of women. 

4. In cystitis. 

5. In cardiac pain. 

6. For arresting glandular secretions. 

7. For nocturnal incontinence of urine in children. 

Hyoscyamus. 

Hyoscyamus has the properties of belladonna and no other. 
There is no difference between them except in activity. The 
extract of hyoscyamus is a very uncertain preparation, and can- 
not be depended on in all cases, compared to the true and well- 
known dose of belladonna. Its alkaloid, hyoscyamine, how- 
ever, is very powerful, more so than atropine. There is virtually 
no difference in action between the two. 

Stramonium. 

Stramonium is the leaf of a weed found all over the United 
States. These leaves are dried and broken up in the same way 
as tobacco, and used in the same manner, viz., by inhaling the 
smoke. This smoke inhaled into the bronchial tubes produces 
an immediate effect upon asthmatic paroxysms, more than when 
atropine or belladonna is taken internally, and hence it is used 
almost entirely for this purpose. All of this class are good ano- 



184 NOTES ON MATERIA MEDICA. 

dynes for the relief of pain in fibrous tissue, and notably where 
the pain is due to overstretching. Against a sprain belladonna 
or stramonium is more effective than opium; hence when there 
is inflammation or injury involving fibrous tissue, the addition 
of either of these two medicines markedly increases the action of 
opium, and opium helps them also. On account of this ano- 
dyne action, atropine and morphine should be given in sciatica, 
and also in sprains in the back from lifting. In sprains about the 
ankle, etc., an ointment of atropine and morphine should be used. 

V. Cannabis Indica. 

The flowering tops of the female plant of Cannabis sativa, 
which grows in the East Indies. 

Indian hemp does not affect all persons similarly, and race 
and climate are supposed to modify its influence. Its effects 
are most marked on the brain, whose functions it more or less 
perverts in various ways. It generally produces a pleasurable 
intoxication. The patient is possessed with a feeling of happi- 
ness and contentment, and ideas of a pleasing kind pass rapidly 
through the mind, sometimes unconnected and immediately 
forgotten, but in some instances recollected on the return to the 
normal state. Sometimes there is furious delirium. The eyes 
are bright and shiny. Pressure on the skin may excite a sensa- 
tion of burning. After a time, complete anaesthesia sets in to 
such an extent that while standing there may be no consciousness 
of touching the ground. If indulged in for a long time, as is 
common in the East, it produces loss of appetite and strength, 
trembling, and much mental weakness. 

Dilatation of the pupil and disorders of vision, which con- 
tribute to the hallucinations by the distortion of external objects, 
are produced by Cannabis Indica. It has been employed to re- 
lieve pain, and as a substitute for opium in neuralgia and as a 
hypnotic. It is a valuable remedy for migraine, or sick head- 
ache. It appears to act upon the nervous system, from whence 
this headache is derived. It is useful in those cases accom- 
panied with little or no nausea, or in cases with severe vomit- 
ing; it is also useful in those attacks accompanied with spectra. 
It is well established that hemp has the power to promote uterine 



.MEDICINAL REMEDIES. 185 

contractions. It does not cause them, but it increases their 
energy when action has begun. Cannabis Indica is useful in 
Menorrhagia, and especially in that form which occurs at the 
menopause. It is also useful in cases of functional impotence, 
and may in this disease be combined with ergot and nux vom- 
ica. In some cases, it acts well as a diuretic, and hematuria is a 
special indication for its use. It can also be employed in dys- 
uria and strangury, and is useful in retention of urine depen- 
dent on paralysis of spinal origin. 

Preparations — Extractum Cannabis Indicse (dose, gr. i-ij.)? 
Extraction Cannabis Indices fluidum (dose, TT[ ij.-iv.); Tinctura 
Cannabis Indicse (dose, tt[ vi -xxx.). 

(o) Those Medicines which are Stimulants only. 



1. 

2. 
3. 
4. 


Digitalis. 
Strophanthus. 
Nitroglycerin. 
Caffeine. 


6. 

7. 
8. 
9. 


Ergot. 
Strychnine. 
Camphor. 
Asafcetida. 


5. 


Ammonia. 


10. 


Valeriana. 



I. Digitalis (Foxglove). 

The leaves of Digitalis purpurea, from plants of the second 
year's growth. Digitalis is a biennial plant, indigenous to 
southern and central Europe, particularly in the western sec- 
tion, and grows wild as far north as Norway, likewise in Ma- 
deira and the Azores. It is a cardiac stimulant, and is given for 
the purpose of increasing the contractile power of the heart and 
to cause it to recover as far as possible, even in organic changes, 
its natural size. 

Digitalis is a very old remedy comparatively, and in former 
days it was noted that its action was to slow the heart if given 
continuously, and also to make the heart beat intermittently, 
and so it was classed as a pure heart sedative. This was previ- 
ous to the careful studies of physiologists in their experimenta- 
tion on animals. When we have a living heart exposed, to 
watch the effects of digitalis, we find that it produces a pecu- 
liar tonic contraction of the heart, particularly of the walls of 



186 XOTES OX MATERIA MEDIC A. 

the ventricles. The contraction is not uniform, but cramp- 
like, not all of the fibres of the heart equally participating; and 
so the heart presents a streaked or nutmeg appearance, as it is 
called, owing to the contracted fibres turning pale, those not 
contracted remaining relatively redder. This contraction is 
mainly due to the prolongation of the systole at the expense of 
the diastole. Digitalis increases the systole at the expense of 
the diastole, and if given continually, even where there is a 
normal heart, causes death by increasing the systole without 
any subsequent diastole or relaxation, the heart cavities growing 
smaller and smaller. This demonstrates the uses and dangers 
of digitalis, and explains, when acting as a poison, one symptom 
particularly, namely, the inter mittency of the pulse, because 
the heart does not relax and skips a beat. With this condition 
there is persistent and dangerous nausea and vomiting. 

The cumulative effects of digitalis are sometimes produced 
where, after the drug has been taken for a number of days, 
there will be persistent nausea and vomiting, often lasting for 
several days. In some cases, it will appear almost impossible 
to discover the cause of the vomiting until the intermitten- 
cy of the pulse leads to the suspicion of digitalis poisoning. 
Hypodermatic injections of morphine should be given. The 
vomiting is caused by cerebral anaemia, and should be counter- 
acted by morphine, because it produces relaxation of the heart. 

Digitalis is therefore the medicine for dilatation of the heart 
due to the relaxation of its muscular walls beyond their normal 
capacity. It is not a loud murmur that indicates great danger, 
as heart disease of a valvular kind never gives any trouble until 
the heart is not able to empty itself at each stroke. When this 
happens, then commences the general systemic disturbance of 
the circulation. When unable to wholly expel its contents, the 
heart becomes much dilated, and here a remedy is needed that 
shall contract the heart enough to bring it back to its natural 
size. Digitalis does not increase the contractile power of the 
heart in the way that alcohol and ammonia do, but the heart 
remains permanently smaller so long as it is under the effects 
of digitalis. This explains its whole action. It is not a car- 
diac stimulant in the sense that ammonia, alcohol, and brandy 



MEDICINAL KEMEDIES. 187 

are, yet it is often given by physicians in the most routine way 
in pneumonia or typhoid fever where the danger is not of a 
dilated heart, but of a weak heart. Where the heart is only 
weak and not dilated, digitalis does no good. Apparently, 
therefore, digitalis is a typical medicine for dilatation of the 
heart; but, unfortunately, it has another effect, namely, it con- 
tracts not only the heart, but also the muscular coats of the 
arteries: not the aorta — for there the coat is elastic — but the 
small arteries, and the smaller they are the more they feel 
the effect of the drug. How does it do this ? On the coats of 
the arteries the vaso-motor nerves are distributed, and wherever 
there is a division of the artery, there we find a little ganglion, 
and at the next division another little ganglion of the vaso- 
motor system, and so on. These ganglia, instead of being acted 
upon all at once, are sometimes acted upon from the periphery, 
as in Bright's disease, or, as when digitalis is administered, 
from larger ganglia downwards. So in the latter case we 
find that when the heart is through with the action of digitalis, 
the little arteries are not, and so there is an obstruction which 
undoes all the good obtained from digitalis in strengthening the 
heart. The addition of nitroglycerin, however, overcomes this 
arterial obstruction, and we lose nothing of the action of digi- 
talis on the heart in combining these two drugs with strophan- 
tus, as nitroglycerin itself is a cardiac stimulant^ The com- 
bination of these drugs is very gratifying in its effects in all 
cases of heart failure due to obstruction of the circulation. It 
can be given also in angina pectoris, many of these cases being 
due to chronic obstruction in the arterioles, the heart being 
simply tired out from endeavoring to overcome this obstruction. 
Another of the actions of digitalis equally beneficial is in treat- 
ment of chronic Bright* s disease, where there is serious disturb- 
ance in the circulation over the whole body, due to toxmmic 
poisoning irritating and contracting the arteries. This disease, 
with sometimes one exception, namely, amyloid degeneration, 
gives a characteristically small, incompressible pulse. Here 
digitalis may be given to enable the heart to overcome its great 
tax of contracted arteries and the dilatation going on from con- 
stant obstruction. Digitalis should be given for the heart and 



188 :n"otes ox materia medica. 

nitro-glycerin for the arteries. Under this treatment Bright^ 
disease shows decided symptoms of improvement, there being 
less albumin in the urine, with higher specific gravity. 
The following can be used for chronic Bright's disease: 

$ Hydrargyri Bichloridi, gr. i. 

Pulveris Digitalis, ...... gr. xxiv. 

Quininse Sulphatis, . . . . . gr. xxiv. ' 

Massse Ferri Carbonatis, 3 ij. 

Misce et fiant pilulae No. xlviii. Sig. Two pills t. i. d. after 
eating. 

Digitalis is also a diuretic of a kind which can be given with- 
out fear where there is engorgement or congestion of the kid- 
neys from acute nephritis. It is the remedy, therefore, in the 
nephritis of scarlatina, where a saline diuretic cannot be given, 
nor an irritant diuretic like ether or turpentine. The reason 
why digitalis can be given is that it produces the same kind of 
change in the circulation of the kidneys that occurs whenever 
there is a shock given to the whole arterial system. It operates 
on the kidneys, therefore, in the same way that fear does. 
When a man is frightened, the heart contracts, also intermits; 
he is nervous, cold, turns pale — all indications of vaso-motor 
spasm, producing a diuretic effect, as is frequently shown by 
incontinence of urine. Digitalis acts much in the same way in 
certain conditions of hysteria, and in spermatorrhoea due to 
weakness and debility. A stimulant of this kind produces a 
contraction of the arteries of the part. In epilepsy, there is one 
curious condition where digitalis does good, namely, where there 
is more or less intestinal disturbance and the patient has a bad 
breath, either before or during the convulsions. Anything like 
this should always be inquired for, also if there is diarrhoea or 
obstinate constipation accompanying, preceding, or following the 
convulsion. These peculiarities are often due to intestinal fer- 
mentation and the resultant poisoning. Digitalis always does 
good here, of course combined with other things. 

Finally, as to its action in pneumonia. In typhoid fever, it is 
of no use at all. Never give it in diphtheria, worse results pos- 
sibly following from its administration than from the disease it- 
self, because it interferes with the peripheral circulation, which 



MEDICINAL REMEDIES. 189 

is the first thing that fails in prostrate conditions of heart fail- 
ure. Nor should it be given in fatty degeneration of the heart, 
where it does no good. But in certain conditions of pneumonia 
it does a great deal of good, namely, where the right side of the 
heart is embarrassed and there is danger of death from its being 
unable to drive the blood through the lungs ; this rarely hap- 
pens until the temperature falls, and hence this is the indication 
for giving digitalis, and at the same time iron in large doses. 
Therefore, when the patient has a low temperature coming on 
instead of high ; if he turns blue, particularly if the lips turn 
blue when the patient is turned over from side to side, or if 
foolishly raised when the pulse is weak, these are very grave 
symptoms of prostration, because the right side of the heart is 
dilated and exhausted with its futile efforts to drive the blood 
through the lungs. Then it is that digitalis with oxygen gas and 
iron may be given with great success. Cases of alcoholic pneu- 
monia are most likely to produce this condition. In acute pneu- 
monia with high temperature, it should not be given, because 
here the heart is not dilated. 

Digitalis should not be given for weak heart simply, not being 
a tonic in that sense, but only in cases where the heart is dilated 
either temporarily or permanently. In fevers, on the other 
hand, where the danger is of the patient dying from heart exhaus- 
tion, in the fatty state produced by the febrile process (fever is 
now considered to be a trouble of the muscles, heat being gene- 
rated there in excessive amount), digitalis is not only useless but 
positively mischievous. To overcome the arterial obstruction 
caused by digitalis, combine it with nitroglycerin and strophan- 
tus, which forms practically a new medicine. (We now know 
that hypertrophied muscles have a greater tendency to fatty de- 
generation than natural muscles; this is to be borne in mind, for, 
consequently, when the heart hypertrophies there is a greater ten- 
dency to fatty degeneration. In one of the English manufac- 
turing towns, where there is a large class of artisans engaged in 
hammering brasswork, there is found in many of them hy- 
pertrophy of the biceps muscle owing to their occupation, and 
a large number of cases have total atrophy. Apparently the hy- 
pertrophied biceps becomes more prone to fatty degeneration.) 



190 K"OTE8 OK" MATERIA MEDICA. 

Preparations.— Pulvis Digitalis (dose, gr. i.); Extractum 
Digitalis (dose, gr. £); Infusum Digitalis, 3 i.-Oss. (dose, 3 i.- 
3 iv.); Tinctura Digitalis, I ij.-Oi. (dose, tt[v.-xx.; Extractum 
Digitalis fluidum (dose, TT|i.-ij.). 

The tincture is not always reliable. The best preparations 
are the infusion freshly made from the English leaves, and 
SquibVs fluid extract. 

II. Strophantus. 

Strophanthus hispidus is an African plant found both on the 
western coast of the continent of Africa, in Senegambia and 
Guinea, and on the eastern coast along the Zambesi River; its 
alkaloid is one of the most virulent poisons known, and is used by 
savages on the coast of Africa for poisoning their arrows. A dose 
of one two-hundredths of a grain is sufficient to kill a strong dog. 
It is given only in the form of a tincture. Its operation is more 
definite than that of digitalis, if it is a good preparation. Un- 
fortunately, however, it is difficult to obtain a good preparation 
of uniform strength, but when its alkaloid becomes cheaper 
we may be able to use that. At present, we have to rely upon 
the tincture, and of a good preparation of this medicine the 
dose for an adult ought to be four drops, from that up to ten, 
but not beyond. The action of strophanthus has been very 
thoroughly studied. It has the following excellent properties: 
it is a stimulant of the same nature as digitalis, so far as the 
heart systole is concerned, producing a strong, steady, uniform 
systole, and it also interferes with the diastole, but not to the 
same extent, as it does not produce intermittency except when 
given in large doses. Its chief value is that it does not contract 
the arteries and raise the blood-pressure to the same extent, or 
so soon, as digitalis. Strophanthus is, therefore, one of the 
best medicines for use in heart failure, and, on the whole, is to 
be preferred to digitalis for this purpose. There are two forms 
of heart failure: one from muscular overexertion, the other 
from inherent inability. Of the former, we have failure from 
valvular or chronic arterial disease; of the latter, we have many 
cases where there is no hypertrophy and no dilatation, and so 



MEDICINAL REMEDIES. 191 

we ascribe the heart failure to simple deficient innervation (this 
trouble has increased very much in the past ten years). One of 
the signs of heart failure is palpitation. In many cases, the 
heart, instead of failing at once, commences with weakness, 
indicated by irritability, causing palpitation. There are some 
diseases in which palpitation, as such, is very distressing; for 
instance, in Basedow's or Graves' disease, where commonly we 
have enlargement of the thyroid gland, and with this excessive 
nervousness, excessive rapid action of the heart causing a visible 
throbbing of the arteries all over the body. Its exact cause is 
not known, but it is thought to be due to poisoning from fer- 
mentation in the intestines. In hysterical, nervous persons with 
dyspepsia, there is frequently palpitation without murmurs or 
valvular disease, and this is evidently due to deficient power of 
the heart, caused by paralysis of its inhibitory mechanism. The 
strength of the heart is shown, not by its rapid beat, but, on 
the contrary, by the ability to restrain it from beating too fast 
in conditions of nervous disturbance or in great emotion. Where 
the palpitation is due to great sensibility to nervous emotion and 
nervous irritability, and to vaso- motor disease, strophanthus is 
the best remedy by far that is known. Strophanthus increases 
the power of the heart's action, and does not have the same effect 
in raising the tension of the pulse by interfering with the calibre 
of the small arteries, and is of special use where the heart is 
weakened from nervous causes, as in functional palpitation (the 
majority of these cases, however, are due to intestinal fermenta- 
tion, and should be treated dietetically and by intestinal anti- 
septics). In strophanthus, we have the best remedy for func- 
tional palpitation of the heart, and it is a great adjuvant to 
digitalis, and is frequently combined with it in the treatment 
of heart failure in pneumonia and in the treatment of cardiac 
dropsy. We have other agents that have the same power to 
assist a failing heart, and one is nux vomica. This added to' 
strophanthus works in the same way that a small dose of ipeca- 
cuanha added to opium acts as a diaphoretic. Nux vomica by 
itself is not a pronounced cardiac stimulant, but added to stro- 
phanthus it increases the power of the latter, and conversely. 
In dropsical disease of the liver due to weak heart, a form that 



192 NOTES ON MATERIA MEDICA. 

occurs whenever there is regurgitation on the right side, the 
person becomes jaundiced, has gastritis, this combination is use- 
ful. 

III. Nitroglycerin. 

The action of nitroglycerin as a medicine is extremely rapid. 
Given in proper medicinal doses, it operates as quickly as ether, 
the first effect being a rapid dilatation of all the arteries, pro- 
ducing an uncomfortable sensation about the head, similar to 
that produced by alcohol or by some great mental emotion. 
Pain is a prominent symptom; the eyes are suffused, there is 
ringing in the ears, etc. The heart begins to beat quickly with 
powerful contractions, similar to those produced by alcohol or 
ether. 

Nitroglycerin is an extremely valuable medicine in pneu- 
monia, for in this disease the great danger is from arrest of the 
circulation in the lungs, where the circulation suddenly ceases 
in one part of the lung; the remaining portion, being unable to 
adapt itself to the sudden change, becomes highly embarrassed, 
congestion and pulmonary oedema take place, and this condition 
affects the heart, embarrassing that also in its action, and, as 
the result, the patient sinks from great prostration. 

The stimulating treatment of pneumonia by large doses of the 
carbonate of ammonia and alcohol is often discouraging. 

The treatment of the present time consists in giving digitalis 
and strophanthus in small doses to increase the systolic power 
of the heart. Unfortunately, with both of these agents, and 
especially with digitalis, nothing is gained ultimately, for, al- 
though the heart is strengthened, the arteries are contracted 
and the extra strength of the heart is expended in overcoming 
the increased arterial resistance, the one balancing the other. 
In all these cases, nitroglycerin should be combined with digitalis 
and strophanthus. In cases of pneumonia with high fever and 
no indication of heart failure, aconite should be given; five 
drops of the tincture of aconite with 3 i. doses of the sweet 
spirit of nitre every two or three hours, according to the 
urgency of the symptoms. As soon, however, as the respira- 
tions begin to increase and the pulse becomes weak and irregu- 



MEDICINAL REMEDIES. 193 

lar, commence with cardiac stimulants, strophanthus, digitalis, 
and nitroglycerin, to be administered together, and, if occasion 
demands, these remedies should be pushed. 

As has been already said, nitroglycerin has a special power of 
relaxing the arteries, which property it has in common with the 
nitrite of amyl, but the former is more permanent. Hence it is 
the medicine for high arterial tension, which indicates that the 
calibre of the arteries is diminished, and we infer from this 
that the trouble is in the small arteries throughout the body, 
producing a tendency to dropsy, due to the venous current not 
receiving proper impulse, and hence the serum of the blood 
exudes into the surrounding tissues. This will be most appa- 
rent where the veins are not pressed upon to any extent by 
muscles and not provided with valves; hence in Bright' 's disease 
the face becomes puffy, etc. This condition will lead to heart 
disease, first hypertrophy, then dilatation, owing to the in- 
creased amount of work imposed upon the heart in driving the 
blood forward. Hence in Bright's disease, and in all diseases of 
the heart due to hypertrophy first and dilatation afterwards, 
nitroglycerin should be used for the purpose of dilating the 
arterioles, and thus relieving the heart of much of its burden of 
work; consequently it is a great adjuvant in the treatment of 
anasarca, and also of great benefit in increasing the power of 
the kidneys to excrete urea and diminish the amount of albumin 
in the urine, notably in the chronic interstitial form of Bright's 
disease with a hard, incompressible pulse. 

Nitroglycerin is a medicine which, like all powerful neurotics, 
acts differently upon different persons, there being many so- 
called idiosyncrasies to take into account in administering it, 
some persons being unable to take even extremely minute doses, 
while others can take comparatively large ones with impunity. 

The dose to begin with should not exceed gr. jfo, and if dis- 
agreeable symptoms are produced the dose, should be reduced to 
S r ' Fo"o* Usually, however, gr. y^ is well borne, and after a 
time the dose may be increased to gr. ^-g or gr. -£$. In some 
cases of chronic Bright's disease, it maybe necessary to increase 
to g r - 3W0- or even to gr. T \. 

The pain of angina pectoris is greatly relieved by the admin- 
13 



194 XOTES O^ MATERIA MEDICA. 

istration of nitroglycerin. If it is the first attack (this disease 
is dangerous from the very first, death resulting in some cases 
from the first attack), the nitrite of amyl should be given by 
inhalation; five drops can be inhaled, the nitrite of amyl being 
more rapid in its action than nitroglycerin. Angina pectoris is a 
severe neuralgic pain in the heart, and very frequently muscular 
spasm of the heart due to overwork. Any muscle when cramped 
gives rise to a severe pain, owing to the pressure upon the nerves 
caused by the muscular contraction. In angina pectoris, the 
patient feels as if he was going to die; the pains radiate to the 
left arm. This symptom should always excite suspicion. Pain 
over the region of the heart is not comparatively of much account 
unless it radiates to the arm, and then the cause of pain is in the 
heart itself. 

In some instances the pain radiates to the right arm and also 
into the neck, but generally it is felt in the left arm. Therefore 
any cardiac pain caused by valvular disease radiating into the 
left arm will be relieved promptly by the nitrites, nitroglycerin 
and nitrite of amyl. The arteries should be carefully examined; 
if high tension with rigid arteries be present, give nitroglycerin 
t. i. d. with iron as a cardiac tonic, and prohibit the use of ni- 
trogenous food; meat, when taken largely, having a tendency to 
aggravate the rigidity of the arterioles. 

The patient should be placed in the open air as much as pos- 
sible. In headache combined with coldness of the surface of 
the body, pale face, pulse small and sometimes incompressible, 
nitroglycerin often does good. 

Tinnitus aurium, which sometimes is an extremely obstinate 
and distressing complaint, in a few cases is relieved by nitro- 
glycerin. 

IV. Caffeine. 

Coffee is indigenous to tropical Africa, more particularly to 
Abyssinia. It grows wild in Central Africa and on the coast of 
Mozambique, and was introduced into Java near the close of the 
seventeenth century, and into the West Indies and South 
America during the eighteenth century. Caffeine is an alkaloid 
which is at the base of tea, coffee, cocoa, etc. It is very widely 



MEDICINAL REMEDIES. 195 

dispersed and possesses curious effects, both chemically and phy- 
siologically. Coffee is allied to uric acid so closely that it 
can be made from it; hence it seems as if man has been using 
materials allied to those found in the body due to the retrograde 
metamorphosis of the system; for uric acid is an irritant, pro- 
ducing gout where there is an excessive quantity of it. Large 
quantities of tea, coffee, etc., will also aggravate a gouty condi- 
tion. Caffeine markedly increases the stroke of the heart by 
increasing its contractile power. Hence it is good practice to 
keep up the effectiveness of neurotics by using them inter- 
changeably. Where digitalis, strophanthus, or the other remedies 
are losing effectiveness, one-, two-, or three-grain doses of caff eine 
may be used for a time instead. In some cases, it is not borne in 
larger doses than one grain. If not well borne, the symptoms are 
tremor of the muscles, similar to that produced by excessive use 
of tea or coffee, and the patients feel uncomfortable about the 
head. Generally begin with one grain of the citrate of caffeine 
and increase to two or three. It is also very good in asthma, 
particularly where there is a good deal of bronchial congestion, 
in which patients raise a considerable amount of watery expec- 
toration after the asthmatic attack. Not uncommonly these 
are cases of chronic asthma where there is some emphysema 
and weakness on one side of the heart. 

Lastly, there is a mineral, proved to have an action on the 
heart similar to that of digitalis, viz., chloride of barium. 
It is quite a powerful poison in large doses. Not more than 
one-fourth of a grain should be given. . Some cases of heart 
failure are quite susceptible to the action of barium. 

Therefore, to sum up, there are six great medicines for palpi- 
tation of the heart, both with and without dropsy, producing 
effects upon the portal circulation, heart weakness, and heart 
failure, which are shown by a tendency to palpitation; these rem- 
edies are, digitalis to lead, strophanthus, nitroglycerin, 
nux vomica, caffeine ; and to these vegetable remedies should 
be added the mineral chloride of barium. All these remedies 
sooner or later disturb the stomach by interfering with the pa- 
tient's appetite. There is repugnance of food, and later on 
nausea and vomiting, and when this sets in it is very difficult to 



196 NOTES ON MATERIA MEDICA. 

control. As soon as the patient becomes nauseated, their use 
should be intermitted for a good while, as the stomach has 
strong prejudices, and it may be some weeks before they can be 
tolerated again. 

T. Ammonia. 

Ammonia is one of the most volatile of the alkalies, and has 
some special actions apart from its neurotic properties. Alkalies 
are usually fixed and pretty strong in their alkaline forms, but 
ammonia is very diffusible and operates with promptitude. 
Many cases of headache from acidity of the stomach have been 
relieved by a teaspoonful of the aromatic spirits of ammonia. It 
relieves this because, being an alkali, it counteracts the acidity of 
the stomach. It is also useful in those slight headaches caused 
by using tea too freely. Besides this, on account of its alkaline 
action when taken into the blood, it has the effect of diminish- 
ing the coagulation of fibrinous exudation. There is no doubt, 
therefore, that it is proper to rank ammonia among the expec- 
torants, if by that term we mean, as we should, a remedy that 
facilitates expectoration. "When mucus is difficult to expel on 
account of being viscid from excess of albuminous material, as 
in certain forms of bronchitis, inhalations of ammonia should be 
given. Until recently, evidence has been very strong in favor of 
the use of the carbonate of ammonia in the treatment of pneu- 
monia, on account of its action as a cardiac stimulant and a 
liquefier. In the early stage of pneumonia, when vascular ex- 
citement has subsided and there is coughing, it does good in 
helping to raise the expectoration; but it is now considered that 
the danger in pneumonia is not from suffocation, but from 
weakness of the heart. 

Ammonia is a direct stimulant of the heart, of the same kind 
as alcohol, increasing the rapidity and force of the beats, and 
dilating the arteries, causing a warm perspiration all over the 
body. Moreover, it is a stimulant which does not cause the 
slightest depression, as is the case when too much alcohol is 
given, because it is a pure stimulant and not a sedative. Am- 
monia is particularly indicated when rapid stimulation of the 
heart is required, as in syncope or hemorrhage. The ammonia 



MEDICINAL REMEDIES. 197 

may be combined with brandy, this being a time-honored resource 
in pneumonia. 

Whenever there is a severe cramp, notably in the tubular struc- 
tures of the body, as in the ureters during the passage of gall 
stones, or in the intestines, the result is to produce cramps else- 
where. In cases of severe griping, there are cramps in the calves 
of the legs, as shown in choleraic diarrhoea, the patient becoming 
cold and the pulse small. All griping is accompanied with cold- 
ness of the extremities. A good dose of ammonia relieves this 
quite markedly. Similarly a stimulant dose gives great relief in 
those neuralgias where the patient has coldness of the surface 
of the body and extremities. 

Ammonia is a decided diaphoretic. Five-grain doses, given 
every hour or two, cause the patient to perspire very freely. 
Some preparations are more powerful than others in this respect, 
but all are classed under the head of diaphoretics. The carbo- 
nate is the best cardiac stimulant. As the salts have a sharp 
taste, they should be given in mucilage, syrup, or licorice. The 
carbonate should be only given in lobar pneumonia. Five grains 
should be given every hour or two during the entire course of the 
disease, but care should be taken that the patient is not chilled 
after sweating from this treatment. Its action is still more 
rapid against syncope. A comparatively pleasant preparation 
to take is the aromatic spirits of ammonia in doses of one tea- 
spoonful at a time, to be repeated every ten or fifteen minutes, 
for its expectorant action. In broncho-pneumonia, the chloride 
of ammonia should be given in doses of from ten to twenty 
grains every two or three hours. In certain forms of neuralgia, 
notably that of the face known as tic douloureux, good results 
have been obtained by giving thirty-grain doses of muriate of am- 
monia every two hours. It works better with quinine or ginger. 
An old German prescription, that is very successful in some cases 
of severe neuralgias of this kind, consists of thirty grains of the 
chloride of ammonia in . two-thirds of a tumblerful of a strong 
infusion of horse radish, the whole amount to be taken in one 
dose. 

It is claimed that the chloride of ammonia is a good chola- 
gogue in jaundice. It is the favorite treatment of British sur- 



198 STOTES ON MATERIA MEDICA. 

geons in India for chronic hepatic congestion. Thirty grains of 
the muriate of ammonia are given every two hours to a patient 
with an enlarged and tender liver from malarial disease. It is 
said that after three doses have been taken the patients cry out 
with pain, describing it as a feeling as of the breaking of the 
attachments of the liver, and shortly after the liver rapidly di- 
minishes in size and the patient recovers. 

VI. Ergot (Secale Oornutum). 

Ergot is a fungus, the sclerotium of Claviceps purpurea replac- 
ing the grain of Secale cereale; chemically it is a compound sub- 
stance, and none of its elements have been obtained in a crys- 
talline form. Ergot is a stimulant to the vaso-motor nerves, 
causing tonic contractions of the unstriped muscular fibres in 
the different parts of the body. 

Vascular System. — Its action upon the circulatory system is 
almost entirely confined to the muscular coats of the arteries. 
In large doses, it produces tonic cramps or spasms of these 
fibres, and along with this, feeble heart beat and a fall of tem- 
perature all over the body, while in moderate doses it only pro- 
longs their natural contraction. When its use is continued, it 
produces anaemia of the surface of the body, and especially of 
the brain. Dependent on this action is its use in subacute and 
chronic meningitis (cerebral and spinal). In this disease, the 
blood-vessels are enlarged, and there is hyperemia of the brain. 
Ergot should be given until its effects are seen. The tolerance 
of ergot in these cases is remarkable, the dose being about ten 
times as large as in other conditions. It should always be 
administered without regard to the size of the dose. As a rule, 
those forms of meningeal trouble that contra-indicate strychnia 
are benefited by ergot, and vice versa. It is especially useful 
against the chronic dilatation of the arteries of the brain after 
sunstroke. In this condition, its action should be aided by 
cold douches to the nape of the neck. It is also useful in epi- 
lepsy following exposure to great heat and characterized by 
flushed face, photophobia, apprehension or fear of responsibili- 
ties, vertigo on stooping over and when exposed to the sun, 



MEDICINAL REMEDIES. 199 

bright specks before the eyes, and headache of a confused kind, 
attended with insomnia and slow, rapid, and irregular pulse. 
These are all symptoms of chronic cerebral irritation, and may 
be cleared up by ergot and corrosive sublimate. 

Genito- Urinary Tract. — In spermatorrhoea due to great weak- 
ness and irritability^, ergot is one of the best remedies. The 
fluid extract can be combined with the elixir of cinchona, two 
teaspoonfuls to be taken at night. Ergot is also given for the 
purpose of exciting uterine contractions when deficient in them- 
selves, or to procure contractions of the uterus in the last stage 
of labor; hence the common practice is to prevent relaxation 
likely to occasion post-partum hemorrhage. A teaspoonful of 
the fluid extract should be given as soon as the child is born. 
It should not be given if the birth is likely to be delayed, be- 
cause there is great danger of the child being suffocated by 
arrest of the placental circulation due to the action of ergot 
upon the uterus, producing tonic contraction without relax- 
ation. In chronic subinvolution of the uterus, ergot should 
be used persistently. Ergot may also be used in the treatment 
of tumors of the fibroid variety. Injections into them some- 
times cause them to diminish in size. It can also be used in 
the same way for enlarged spleen, viz., injections being made 
directly into the structure of the spleen itself. 

Acne occurring in young women and aggravated at the men- 
strual period is sometimes relieved by ergot; but as this is very 
difficult to treat, and as it depends so much upon the stage of 
digestion and disturbance of the genital organs, particular atten- 
tion should be paid to this, especially to digestion; sugars and 
all fats being eliminated from the diet, and the benzoate of 
sodium administered internally, with charcoal and salol, in small 



Hemicrania is not infrequently dependent on paralysis of 
the vaso-motor nerves of one side of the head, as indicated by 
throbbing of the arteries of the side affected and dilatation of 
the pupil, with photophobia and suffusion of one eye, and ring- 
ing in the ears. Ergot will often relieve these symptoms, if 
taken in full doses until no more can be borne. It may be 
advantageously combined with antipyrine. The ergot may be 



200 KOTES 0!tf MATERIA MEDICA. 

administered internally, or injected nypodermatically into the 
nape of the neck. It should only be given at the beginning of 
the attack. The dose is a drachm of the fluid extract every 
hour, if necessary, until three have been given. 

Ergot is a great adjuvant of quinine in brow ague or true 
periodic headaches attended with photophobia. Quinine alone 
will not cure this condition. What is true of the photophobia 
of ague is true of all photophobias not dependent upon inflam- 
mation of the eye. Give a drachm every half-hour until re- 
lieved. 

To control haemoptysis, ergot should be injected hypoder- . 
matically at the nape of the neck. It is also given in dysentery 
to check the profuse hemorrhages which are apt to occur 

Preparations. — Extractum Ergotse fluidum [Squibb's] (dose, 
3ss.-ij.); one drop is equal to one grain of the crude drug. 
Extractum Ergotae (dose, gr. v.-xx.); one grain of this equals 
five grains of the crude drug. 

VII. Strychnine. 

Kux vomica is the seed of the Strychnos nux vomica, a mid- 
dle-sized tree common in many parts of Hindostan, Farther 
India, and some of the East India islands. It is an excessively 
bitter powder, and owes its activity to two alkaloids, strychnine 
and brucine, the leading one, however, being strychnine. This 
is a powerful poison; its actions are peculiar and very definite. 
It produces death by severing the connection of the spinal cord 
with the cerebrum. The muscles are liberated from all control, 
the body is thrown into violent cramps and spasms, and death 
results from tonic contraction of the diaphragm and other 
respiratory muscles. Owing to the severity of the spasms, the 
muscles are frequently torn and the body is arched backwards 
by the contraction of the powerful muscles of the back. These 
symptoms resemble rather closely those of tetanus, and in some 
cases of poisoning by strychnine the defence is raised in courts 
of law that tetanus was the cause of death. The points of dif- 
ference between the two are as follows: In strychnine poison- 
ing, the symptoms develop suddenly; in tetanus, the develop- 



MEDICINAL REMEDIES. 201 

ment of symptoms is always gradual In strychnine poisoning, 
the convulsions appear immediately after the absorption of the 
poison into the blood, the first convulsion being usually the 
most severe. Tetanus comes on with gradual stiffness of the mus- 
cles of the neck; after a time the muscles of the jaw become 
affected, and, after a period varying from several hours to two 
or three days, this stiffness ends in permanent lockjaw. 

Except in rare cases, tetanus takes time to run its course. In 
tetanus, the symptoms make their first appearance in the upper 
extremity — the muscles of the neck and jaw. In strychnine 
poisoning, the symptoms are first manifested in the lower ex- 
tremity, usually in the legs. They both resemble each other in 
this: that the slightest touch, or breath of air, or flash of light 
will throw the body into violent convulsions, owing to excessive 
reflex irritability. As soon as the convulsion is over, in strych- 
nine poisoning, complete muscular relaxation takes place, the 
jaw is open, and for the time being the muscles are quite nor- 
mal. In tetanus, there is never complete muscular relaxation, 
and the jaw cannot be opened. 

Strychnine is of no use as an agent to increase the power of 
the voluntary muscles, and therefore in all cases of true volun- 
tary muscular paralysis, where the region is under the control 
directly of the cerebrum, not of the spinal cord, strychnine 
should not be given. Not so in cases of paralysis of spinal 
origin, as in paraplegia. Here it is of some value, particularly 
in restoring the tone of mixed muscular structures rather than 
the purely voluntary ones — viz., all structures relating to the 
sphincters of the body which are mixed — for, although they be- 
long to the unstriped muscles, every one of them is so arranged 
that the will has a certain power to call into play and arrest 
their action. In cases, therefore, of ivealc bladder, strychnine 
should be given, and is the main neurotic for this purpose. 
Where there is incontinence of urine from loss of the propul- 
sive power or weakness of the sphincter, strychnine is indicated. 
It is the best remedy in treatment of prolapsus of the rectum, 
to which children and aged persons are extremely prone, the 
aged also suffering from piles or congestion of the mucous mem- 
brane about the rectum. In old people, this infirmity has an 



202 NOTES ON MATERIA MEDICA. 

extremely depressing effect on the mind, amounting in some 
cases to insanity of the melancholic variety. In these cases, 
strychnine should be given in solution by submucous injection 
directly into the substance of the tissue itself, this being the 
most effective way to produce good results, and then retain the 
parts in their proper position by bandaging. This injection 
should be given t. i. d., if possible. 

Strychnine in solution is not irritating when given hypoder- 
matically. Care should be taken that the liquid is a good one 
and that the water is distilled. One-fortieth of a grain should be 
given to begin with, and rapidly increased until the desired effects 
are produced. If tolerated, it is possible to give one-tenth or even 
one-fifth of a grain after a time. Strychnine has a good effect 
in all conditions of exhaustion of the lower part of the spinal 
cord; therefore it is contra-indicated where there is an inflam- 
matory condition. Aside from these actions, and in a few cases 
of paraplegia where it may be used cautiously, strychnine has a 
marked effect in increasing the peristaltic movements of the 
alimentary canal, and notably of the intestines, more than of 
the oesophagus. It may also be given in cases of water brash, a 
difficulty in which the patient raises a large amount of clear 
mucus on getting up in the morning. During the night, a 
large amount of mucus is secreted to keep the throat moist, and 
in certain conditions of the oesophagus this accumulates at the 
cardiac end, and in the morning is raised. Strychnine should 
be given. It is also specially indicated in chronic constipation, 
and on this account forms one of the ingredients in a great 
variety of laxative medicines. It is also indicated in conditions 
of vaso-motor weakness, where persons blush without any reason 
whatever, as in the case of women, particularly at the time of 
the menopause. Five drops of the tincture of nux vomica can 
be given in these cases t. i. d. 

Preparations. — Extractum Nucis Vomicae (dose, gr. £); 
Tinctura Nucis Vomicae [ 3 iv. to OL] (dose, tt^x.-xv.); Strych- 
nines Sulphas (dose, gr. jVgV)* 



MEDICINAL REMEDIES. 203 

VIII. Camphor. 

A stearopten or concrete volatile oil obtained from the wood 
of Cinnamomum camphora. It is indigenous to Eastern and 
Southeastern Asia, China, Japan, and the Sunda Islands. 
Camphor is the most diffused of all the substances of the vege- 
table kingdom; it is found in pennj^royal, hemp tops, and a 
large number of plants of this class. The eucalyptus tree seems 
to be destructive to malarial poison on account of the cam- 
phoraceous exudation from its roots, which permeates the upper 
layers of the surrounding soil. Camphor is a member of the 
carbolic-acid series of disinfectants. 1 

Locally, camphor is an anesthetic; it can be used for tooth- 
ache, and notably against inflammatory pains. In the form of 
camphorated oil, it is a good counter-irritant. In order to act, 
evaporation should be prevented by covering it with oiled silk; 
it should not be applied too long, as it will produce a blister. 

Its stimulant action is almost entirely confined to the solar 
plexus of the sympathetic nervous system. It is especially use- 
ful in choleraic diarrhma. 2 

In Asiatic cholera, camphor should be given in combination 
with capsicum every hour. In cholera morbus, teaspoonful 
doses of camphor water shouM be given every ten minutes and 
after vomiting; if an astringent is necessary, acetate of lead can 
be added to it. 

In moderate doses, camphor stimulates the circulation by 
increasing the rapidity and force of the heart's action. It in- 
creases the secretions of the bronchial mucous membrane, and 
is often found in expectorant mixtures, but it has no special 
action in allaying the cough. 

Combined with soporifics, campnor helps to induce sleep. 

Preparations. — Spiritus Camphorae [ 3 ij.— Oi.] (dose, 1U x.- 
3i.); Aqua Camphorae [ 3 i.— Oi.] (dose, 3 i.- 3 ij.); Oleum 
Camphorae (dose, fit i.-vi.). 

For external use, the Linimentum Camphorae (Camphor, one 



1 For the uses of camphor as a disinfectant, see page 29. 

2 See under Opium, page 159. 



204 NOTES ON MATERIA MED1CA. 

part; Olive Oil, six parts) and the Linimentum Saponis, or soap 
liniment, are very popular by themselves, or as the basis of 
more stimulating preparations. 

IX. Asafoetida. 

A gum resin obtained, by incision, from the living root of 
Ferula narthrex. It is indigenous to Central Asia, Turkestan, 
Western Afghanistan, and Bokhara. It grows wild in the 
barren regions between the sea of Aral and the Persian Gulf 
south to Laristan. It is found in the market in the form of 
irregular masses with a strong odor of garlic. Asafoetida is a 
neurotic which stimulates the abdominal sympathetic ganglia, 
and is used to correct functional disturbances only. It is a 
valuable medicine in flatulency accompanying hysteria of an 
emotional character, with cold liands and feet, with paralysis 
of the intestines where some parts are contracted and others 
dilated. It is also capable of removing many of the strange 
complications of hysteria. 

Asafoetida can be used to relieve spasms of the genito-urinary 
tract, also in painful affections of the pelvic organs, as dysme?i- 
orrhcea, amenorrhoea, etc. It can be given for all reflex mani- 
festations due to irritation of the pelvic viscera. Aphonia, 
coming on suddenly without any disease of the throat, is often 
the first symptom of chlorosis, or is due to some menstrual 
irregularity. In all these cases, asafoetida can be given with 
good results. 

It should be given in capsules containing two to five grains 
of asafoetida combined with two grains of ginger and two grains 
of the bicarbonate of soda. It is very apt to disturb the 
stomach, and its action is only obtained after it has reached 
the small intestine. An injection of half an ounce of the tinc- 
ture of asafoetida in mucilage or milk will very often cut short 
a hysterical convulsion. 

X. Valeriana. 

Valerian is a native of Europe from the Mediterranean Sea 
northward, and of Northern Asia, and is cultivated to some 



MEDICINAL REMEDIES. 205 

extent in Holland and England, and, in this country, in New 
England and New York. 

Valerian resembles asafcetida in its antispasmodic action. It 
can be given in hysteria followed by low spirits. In facial neu- 
ralgia and hem (crania with photophobia, occurring in hysterical 
or nervous women, gr. v.-x. valerianate of ammonium, com- 
bined with gr. xxx. of the chloride of ammonium, should be 
given. 

The valerianate of quinine does not differ therapeutically in 
its effects from a mere mixture of the two ingredients. The 
valerianate of zinc is a good antispasmodic; it should be given 
in pill form. 

(c) Those Medicines ivhich are Sedatives only. 

On the application of cold as a remedy, there is primarily ner- 
vous depression of the nature of shock, followed by a reaction 
of the nerve centres impressed, so that ultimately stimulation 
results. On the other hand, if a person be immersed for any 
length of time in warm water of the temperature of 98.5° F., 
there is sedation, bat this is not followed by any reaction, and 
consequently there is great exhaustion, the whole muscular sys- 
tem being relaxed. Sedative neurotics are drugs which resem- 
ble moist heat in their action, as the nerve centres which they 
affect are depressed and no reaction follows. 

The principal sedative neurotics are the following . 

1. Aconite. 5. Conium. 

2. Veratrum viride. 6. G-elsemium. 

3. Tartar emetic. 7. Anaesthetics. 

4. Hydrocyanic acid. 8. Cocaine. 

9. The Hypnotics. 

I. Aconite (Aconitum). 

Aconite is the tuberous root of the Aconitum napellus, or 
monkshood, an ornamental garden plant indigenous to Europe. 
In appearance, it closely resembles the root of horse radish, 
and this has led to many cases of poisoning. Its most active 
principle is an alkaloid called aconitia or aconitina. Aconite is 



206 NOTES ON MATERIA MEDICA. 

a universal sedative, paralyzing particularly the nerves of com- 
mon sensation. Applied externally in such manner as to reach 
the cutaneous nerves, it first produces tingling, and this is fol- 
lowed by numbness and loss of sensation. (When, in the course 
of pathological changes, the patient complains of tingling and 
numbness of the tongue and tips of fingers, it is an unfavorable 
symptom, indicating not only a loss of power, but that this loss is 
paralytic. ) Hence aconite is an anodyne, relieving pain, when lo- 
cally applied, by paralyzing the nerves. When taken internally in 
fall doses, it produces the same symptoms, the patients complain- 
ing of numbness all over the body, but particularly in those 
parts most freely supplied with sensory nerves, viz., the tongue 
and fingers. 

As aconite is a powerful cardiac paralyzer, there is also great 
depression of the heart, indicated by a slow and feeble pulse. If 
the dose be very large, the symptoms of suspension of the heart's 
action are extremely pronounced ; there is deathly prostration, 
and the patient is in a state of great anxiety and moans continu- 
ously; the whole body is bathed in a cold perspiration, there 
is frequent passing of the arms and hands, and, if death, ensues, 
the patient not uncommonly dies in convulsions. 

These are the chief actions of aconite, and from them, there- 
fore, follow its different remedial operations as a medicine. In 
the first place, it is one of the most powerful reducers of tem- 
perature in fevers caused by inflammation. There are two en- 
tirely distinct stages in all inflammations, the acute and the 
subacute, and the treatment of one should be exactly opposite 
to that of the other. 

In the first stages of acute inflammation, there is a very excited 
action of the heart from the irritation of the inflammation; it 
beats strongly and rapidly, and usually there is dilatation of the 
arteries leading to the inflamed part, causing a mistimed and 
very injurious local hyperemia. This is followed by stasis of 
the capillary circulation of the inflamed area, and the blood con- 
tinuing to come in a powerful stream from the arteries, the ca- 
pillaries become clogged, and this increases the trouble and sets 
up oedema with violent pain from the stretching of the nerves of 
the inflamed part. The great indication in the treatment of 



MEDICINAL REMEDIES. 207 

the acute stage is to diminish arterial hyperemia. For local in- 
flammation, as of inflamed knee joint, the best thing to do is to 
apply cold, so as to cause contraction of the arteries and thus sus- 
pend the determination of blood to the part. Where cold, as in 
internal inflammations like pneumonia, peritonitis, etc., cannot 
safely be applied, then the old practice — and not a bad one — was 
to reduce the activity of the heart and of the arterial circula- 
tion by phlebotomy. If this is not done, then give arterial sed- 
atives — medicines that reduce the action of the heart and cause 
less vascular excitement — and for this particular purpose aconite 
answers very well, as it suspends the excitement of the arterial 
circulation, and has a sedative action upon the heart, the very 
thing desired in acute inflammations. It should be commonly 
prescribed, therefore, in all of the acute inflammations that 
come within the province of the physician. Its action is illus- 
trated particularly in the treatment of pneumonia in its first 
stages. Here digitalis, strophanthus, and nitroglycerin should 
not be given, because this is not the time for the administration 
of these remedies; rather than that, we should moderate the ar- 
terial excitement, and for this purpose aconite is very good. So 
also for pleurisy and other inflammatory conditions. 

After a varying period, all these inflammations begin to enter 
upon the subacute stage. The treatment here is just the oppo- 
site to that in the other stage. Instead of sedatives, stimulants 
should now be given, for the purpose of increasing the blood cur- 
rent of the part to clear obstruction. ' Aconite is not to be given 
in pneumonia when the patient's pulse shows that he is weak. 
Heart stimulants should be given instead. Nor should it be 
given in any inflammations when the symptoms of the acute 
stage are subsiding. The purposes, therefore, that aconite sub- 
serves are, to allay arterial excitement and to diminish pain; 
hence it may be given in pneumonia, .pleurisy , and in the severe 
pains of peritonitis, as an adjuvant to opium to relieve the pain 
as well as to allay the arterial excitement. Occasionally aconite 
lias been very beneficial in the treatment of certain forms of 
neuralgia, notably tic douloureux, a very chronic and difficult 

1 See pp. 189, 192. 



208 KOTES 0^" MATERIA MEDICA. 

form to treat. In a certain proportion of cases, we can some- 
times cure these neuralgias by lowering the pulse sufficiently to 
produce a feeling of numbness throughout the body; and this 
may be done by giving aconite in the form of its alkaloid, aconitia. 
In giving aconite regularly, watch its effects on the pulse; when 
it reaches fifty-five beats per minute, discontinue the use of aco- 
nite. 

Prescription for acute neuralgic affections: 

R Extracti Colchici, gr. J 

Extracti Aconiti, .... . gr. | 

Pulvis Ipecacuanha? et Opii, gr. ij. 

Eepeat every three hours. 

Colchicum is here given because that condition of the system 
which manifests itself in men by gout frequently shows itself in 
women by neuralgias. 

Another of the properties of aconite is its specific action upon 
the circulation of the pharynx. When an overdose has been 
taken, besides the numbness and tingling of the tongue and lips 
there is a peculiar sensation about the throat as if it were con- 
stricted, and there is also considerable soreness. Aconite is very 
valuable in the treatment of pharyngiti 's, tonsillitis, quinsy, ab- 
scess in tonsils, and bad sore throat. For quinsy, first give an 
emetic (ipecacuanha), as this causes a profuse flow of mucus 
from the back of the throat, which relieves the intense congestion 
of the part; then give internally fifteen grains of salicylate of 
sodium every three hours; and, if greater certainty is desired, ten 
drops of the tincture of aconite root, which is double the ordi- 
nary dose — five to eight drops — may also be given. A bad sore 
throat is often benefited by giving ten drops of the tincture at 
night. Another of the uses of aconite is against irritable stric- 
ture of the urethra, where, though desirable, it is sometimes 
very difficult to pass a catheter. Inject into the rectum a dose 
of from eight to ten drops of the tincture of aconite. This has 
a paralyzing effect upon the rectum, sometimes causing a slight 
degree of prolapsus, but its action upon the contiguous organ, 
produced in about fifteen minutes, is very marked. 

Aconite acts as a diaphoretic when in combination with 



MEDICIKAL REMEDIES. 209 

Dover's powder. This combination has the advantage of requir- 
ing smaller doses of Dover's powder than when the latter is 
given alone, and the disadvantages of the aconite are counter- 
acted. 

Aconite is also valuable as an antipyretic, as it depresses the 
heart's action and thus slows the arterial current. The follow- 
ing formula will be found useful as an antipyretic: 

B Tincturae Aconiti Radicis, .... gtt. iij. 
Tincturae Veratri Viridis, .... gtt. i. 
Extracti Gelsemii fl., gtt. i. 

M. Sig. Take at one dose. 

This is also good for chronic rheumatism where the tempera- 
ture has been above the normal for two weeks. 

Preparations. — Tinctura Aconiti [Aconite Root § vi., Alcohol 
Oi.] (dose, TT[ i.-v.); Extractum Aconiti (dose, gr. J-J). The 
Crystalline Alkaloid Aconitia [an extremely powerful poison] 
(dose, gr. ¥ ^). 

II. Yeratrum Yiride (American Hellebore). 

This drug is made from the dried rhizome and rootlets of the 
Veratrum viride, an American herb growing in the swampy 
regions of the Southern and Middle States. It is more definite 
in its effects than the veratrum album of Europe, so that the 
latter is now rarely used. 

Veratrum viride is a pure cardiac sedative, and it acts in a 
peculiar way, as it slows the force and frequency of the heart 
without disturbing the rhythm, which aconite does. The 
amount demanded to produce a definite result can be estimated 
by the frequency of the pulse, as it slows the heart in a very con- 
stant proportion to the quantity taken. If, for instance, five 
drops reduce the pulse from one hundred to eighty per minute, 
five drops more will bring it down to seventy, fifteen to sixty, etc. 
In this way, the pulse maybe brought down to fifty-five per 
minute: below this it is not safe to go. As soon as there are any 
symptoms of nausea, the use of the drug should not be persisted 
14 



210 NOTES OX MATERIA MEDICA. 

in, as it shows that the safety limit has been reached, the nausea 
being due to cerebral anaemia. 

The action of veratrum viride is almost exactly the action of 
the lancet in general blood-letting, as it causes the heart to beat 
more slowly and feebly, and the pulse becomes more compress- 
ible. Hence it is the medicine for a rapid and strong pulse; but 
where the rapidity of the pulse is occasioned by weakness, vera- 
trum viride should not be given, and consequently it must not 
be indiscriminately administered in fevers. When the pulse is 
rapid and strong, it may be used in any disorder, as these are 
signs of too much excitement in the circulation, which becomes 
extremely dangerous if the third element of incompressibility is 
added, as then the patient is on the verge of the most dangerous 
of all convulsions These convulsions are purely epileptic in 
character, very severe, followed by unconsciousness, then by 
a return to consciousness. This will be repeated two or three 
times, the periods of consciousness gradually becoming shorter, 
until finally the patient remains in a state of coma, with one 
convulsion following another, until the coma ends in death. 

In the convulsions of puerperal eclampsia, the heart starts off 
beating very rapidly (120 to 140). In a fever, this high pulse is 
not necessarily fatal, but it is so in eclampsia, for not only is 
the pulse both strong and rapid, but it is also incompressible. 
The old practice was to open a vein, and this is always indicated; 
but as the patient is in a dangerous condition, many physicians 
hesitate to do this for fear the patient's death might be ascribed 
by the friends to this method of treatment. If this is not done, 
by all means give veratrum viride, as in this disease it is exactly 
indicated; for, first, it slows the pulse by making the heart beat 
less quickly; secondly, it makes the heart beat less strongly; and 
thirdly, it opens all the arteries and makes the pulse compress- 
ible. When veratrum viride does this, the convulsions stop and 
the patient's life is saved. For this condition give different 
doses than those previously mentioned. Commence with gtt. xx., 
and when convulsions begin give twenty more. It may be ne- 
cessary to give gtt. xx. every twenty minutes. This treatment 
shows the correctness of the rule that the dose of sedative medi- 
cines has not been readied until their symptoms are produced. 



MEDICINAL REMEDIES. 211 

The symptoms of veratrum viride are slow pulse, etc., and until 
these are shown enough has not be. n given. 

A similar condition exists m acute alcoholic poisoning. A 
man sometimes drinks large quantities of whiskey or brandy, and 
falls down in convulsions of the same kind as those previously 
described; the heart is excited, the pulse strong and incompress- 
ible, and the patient has a peculiar form of cyanosis, occasion- 
ally strikingly illustrated in the convulsions of children with 
scarlet fever. Veratrum viride should be exhibited. 

Veratrum viride is sometimes given in delirium tremens, but 
it is only to be recommended in certain conditions of this dis- 
ease. If there is a considerable quantity of albumin in the 
urine, it is not safe to give this remedy; but if the pulse is 
strong, and the patient's system has not been very much weak- 
ened, as the majority of these cases are very unmanageable, ve- 
ratrum viride may be given to keep them quiet. It may be 
given in the drink for which they will be constantly asking 
(dose, gtt. v., repeated, if there is a strong pulse, until vomit- 
ing is induced). Under this treatment, from being very uproar- 
ious and violent they become very quiet, as there is nothing 
like nausea to calm excitement, this being frequently induced, 
by other methods, to quiet hysterical females. 

Veratrum viride is also very effective in acute rheumatism 
where the patient has a rapid rise in temperature (107° to 114°), 
and, if he dies, with heat increasing after death. These cases 
have been successfully treated by the persistent immersion of 
the patient in cold water. ' The immersion may have to be fre- 
quently performed before the temperature is broken, the patient 
often returning to the state of coma between the baths. In 
former days, no case recovered; but now, by giving free doses 
of veratrum viride in addition to the cold baths, many patients 
recover. 

Preparations. — Tinctura Veratri Viridi (dose, TTUij.-viij.); 
Extractum Veratri Viridi nuidum (dose, fT[i.-iij.). 

1 See "Antipyretic Uses of Cold," p. 283. 



212 NOTES ON MATERIA MEDICA. 

III. Tartar Emetic (Antimonii et Potassii Tartras). 

Taken in small doses, this substance produces nausea; in 
larger doses, it acts as a cardiac emetic, i.e., an emetic which 
induces vomiting by depressing the heart's action, thus causing 
cerebral anaemia and general prostration of the system. It is 
due to this fact that tartar emetic is such an extremely power- 
ful paralyzer of the sensory system of nerves, and to a certain 
extent of the motor system. It could be used as an anaesthetic, 
as animals under its influence exhibit no signs of pain when 
their limbs are amputated. Its action upon the blood when 
long continued is disastrous, as it produces an anaemia difficult 
to recover from. As an emetic this drug is not to be recom- 
mended, nor should it be used for any purpose except as a tem- 
porary expedient in the early stages of acute ironc7iitis. The 
beginning of this disease is frequently accompanied by intense 
dyspnoea, the mucous membranes of the smaller tubes being dry 
and tumefied. This is the period of engorgement; the patient 
feels as if a load was upon his chest; he is blue or dusky in the 
face, and has a little, squeaky cough. In this condition, the in- 
dications are to start the bronchial secretions, and for this one 
purpose tartar emetic acts splendidly. Add one grain of tartar 
emetic to a teacupful of water, and give a teaspoonful every ten 
minutes until the patient feels nauseated. As soon as this hap- 
pens, the asthmatic condition of the bronchial tubes relaxes, the 
secretions pour out, and sometimes the whole disorder is aborted. 
Subsequently, when secretions are present, do not give tartar 
emetic. 

IT. Hydrocyanic Acid — Prussic Acid (Acidum Hydrocy- 

anicum DiL). 

This drug, when concentrated, is the most rapid in its action 
of all the liquid poisons, one drop injected into the eye of a dog 
killing it instantly. Many fatal accidents have happened from 
its use in experimental chemistry and in the process of its manu- 
facture. Apparently it kills by the instantaneous stoppage of 
respiration, from its action upon the respiratory centre situated 



MEDICINAL REMEDIES. 213 

near the calamus scriptorius. It acts so suddenly that often a 
terrible scream is given by the patient from the air being forced 
out at once from the lungs, and he falls in convulsions of the 
same nature as those produced by sudden loss of blood. It 
therefore acts upon the source of the pneumogastric nerve, and 
consequently it is in affections of this nerve that it is to be used 
as a medicine. Hydrocyanic acid may therefore be added to a 
cough mixture to allay irritant or useless coughs, due to irrita- 
tion of some one or more of the branches of the pneumogastric 
nerve, upon which it acts as a sedative. ' 

Y. Conium. 

Spotted hemlock is indigenous to the temperate countries of 
Asia, Europe, and North America, and has been naturalized in 
some portions of New England, New York, and in South 
America. It grows in waste places and along streams. 

Conium is a paralyzing poison of the muscular system, some 
muscles being more affected than others; its most characteris- 
tic action being on the muscles of the eye, producing ptosis. 
"When a person is fully under its influence, there is not only 
general muscular relaxation, but giddiness, difficulty of sight, 
and, where a poisonous dose has been taken, death from paraly- 
sis of the heart itself, if not of the muscles of respiration. It 
was used in ancient times in the execution of those sentenced to 
death, as affording one of the most painless modes of extinction 
of life. 

This medicine has a marked value in relieving pains due to 
inflammation of fibrous tissue, as of the periosteum in syphilis. 
Here conium combined with potassium iodide and opium re- 
lieves the pain very much. In pachymeningitis, the addition 
of conium very often relieves that aching of the head so charac- 
teristic of organic mischief in the cranium. It has also been given 
in some forms of epilepsy in addition to other medicines, but 
only in those cases that give meningeal symptoms, notably those 
that occur after syphilis, blow on the head, sunstroke, etc., or 
where there is twitching of the muscles during sleep. Conium 

1 See Coughs, p. 260. 



214 XOTES OK MATERIA MEDICA. 

will promote the operation of the bromides along with chloral. 
It is of particular value in that class of cases where, from very 
early life, there is a lithsemic diathesis, the formation of stone 
sometimes occurring in the second or third year of life — an ex- 
ceedingly dangerous condition if stone is lodged in the urethra. 
After this period, stone is not apt to be formed again until after 
thirty, but all the while there is often vesical irritation, with 
pain referred to the neck of the bladder, so continuous as often 
to undermine the health. These may be termed cases of hyper- 
esthesia of the neck of the bladder, a trouble which sometimes, 
though rarely, affects women; these persons are wonderfully 
relieved by conium (dose, of fluid ext. V\ x. in § i. of water, 
injected into rectum and allowed to remain there). It can also 
be used in cystitis where there is a great deal of pain. 

Owing to the leaves rapidly losing power, ordinary preparations 
are very uncertain, and conium should be given in the form of 
Squibb's fluid extract (dose, vi x.-xv.). The latter will some- 
times produce the symptoms of an overdose — headache, vertigo, 
disorder in movements of the eyes, feeling of numbness, etc. — so 
begin with TT], x., and increase to xv. as the patient can bear it. 

VI. Grelsenaium (the root of G-elsemium sempervirens). 

The yellow jessamine is indigenous to the southern United 
States, growing in moist woods from Virginia to Florida and 
Alabama, and flowering early in spring, beginning to bloom in 
Florida in January, and further north in March or April. 

G-elsemium lessens the frequency of the pulse, but not with 
the same certainty as aconite and veratrum viride. 

It produces vertigo with a tendency to fall forward. It can 
be tried in sick headache where the pain begins in the eyes and 
radiates to the back of the head, with nausea, sallow complexion, 
and high-colored urine; when the urine is pale in color, it does 
not do much good. 

Preparations. — Extractum Grelsemii fluidum [Squibb's] (dose,, 
m iij.-x.), 



MEDICINAL KEMEDIES. 215 



VII. Anaesthetics. 

Ether was discovered in 1846 by Dr. Morton, of Boston, pre- 
vious to the discovery of the anaesthetic properties of chloroform 
by Sir James Simpson. Ethers produce their effects by entering 
the blood through the lungs; and this is almost an isolated fact, 
as the lungs ordinarily will not take up any medicines, as they are 
constructed in such a manner as not to allow the introduction 
into the blood of gases and vapors, with the exception of oxygen. 
In the case of ethers, however, and their allied class of turpen- 
tines, absorption takes place rapidly by the pulmonary air vesi- 
cles, and, when inhaled rapidly after a short period of excite- 
ment similar to that produced by alcohol, the patient becomes 
completely stupefied. This is a true alcoholic stimulation, and 
produces insensibility to pain, although the patient may be con- 
scious that something is being done. Many details connected 
with its administration should be borne in mind. No anaes- 
thetic can be regarded as perfectly safe; for it is incredible, rea- 
soning a priori,thsit the most conservative function of the body, 
the sense of pain, can be interfered with without danger. All 
of them are dangerous, even nitrous oxide. But there is a marked 
difference in the manner in which these different anaesthetics pro- 
duce death. In some cases, this is easily prevented; in others, 
with great difficulty, for reasons that we do not understand. 
Ethers produce anaesthesia by affecting the respiratory centre 
more than that of the heart, and consequently the patient may 
die in a state of asphyxia because he cannot, or does not, breathe. 
Ether is not at all likely to produce its destruction of life to the 
degree that chloroform does, from the fact that it gives us 
warning, and usually the patient can be restored by artificial 
respiration, efforts at resuscitation being more successful than 
when chloroform has been given. 

It was for a long time claimed that no deaths whatever re- 
sulted from the administration of ether. This is not so; but, 
fortunately, the conditions, aside from suffocation, in which 
ether is dangerous are well determined, and are as follows. 
1. In acute inflammation of the kidneys, calculus irritation, 



216 NOTES ON" MATERIA MEDICA. 

etc., because this may suddenly increase and suspend the excre- 
tion of urea, and uraemic poisoning result. 2. In general bron- 
chitis, where there is dilatation of the right side of the heart. 
In emphysema with bronchitis, the administration of ether 
has sometimes proved fatal, not from suffocation, but from the 
system being poisoned with ether vapor. But disastrous re- 
sults happen very rarely. In the great majority of cases, ether 
is as safe as an anaesthetic can be expected to be. Some deaths 
have resulted from operations, while under the influence of ether, 
in which these conditions did not exist; but as to this it can 
be said that deaths had taken place during operations before 
ever anaesthetics were used. With these few exceptions, there- 
fore, ether can be recommended in all cases. 

Chloroform, on the other hand, is extremely treacherous, and, 
when it produces death, does it very suddenly and by an ex- 
tremely minute quantity — in one case, only one drachm, al- 
though in this case the chloroform had probably been inhaled 
directly. 

This indicates without question that deatn is caused by 
cardiac, not respiratory, paralysis, though even here there is a 
difficulty, as sometimes the respirations cease while the heart 
continues to beat; but, as a rule, death results from stoppage of 
the heart. 

A surgeon of Baltimore, from an experience of ten thousand 
cases in which he administered chloroform, and from experi- 
mentation on animals, claims that cases which apparently termi- 
nated fatally while under the influence of chloroform have been 
restored to life by inverting them, as he maintains that death 
from chloroform is due to anaemia of the brain. If this is so, of 
course it renders chloroform a far superior agent to ether in 
every respect. . Chloroform is the much more convenient of the 
two. 

The state of excitement is shorter than in the case of ether, 
or, in other words, it is easier to bring them into the state of 
anaesthesia; moreover, it passes off a great deal more quickly. 

There is not the violent struggle and sense of choking as in 
ether, where the patient sometimes appears as if he was being 
strangled. On the contrary, by chloroform, in the case of 



MEDICINAL REMEDIES. 217 

children and during parturition, the patients pass at once into 
a gentle sleep. 

Another element which shows that at all times we are deal- 
ing with something beyond our depth, is that there are certain 
conditions of the nervous system which make the administra- 
tion of chloroform perfectly safe, in the state of parturition 
very few deaths resulting from its use, this state seeming to 
counteract the effects of chloroform upon the heart. Also, in 
military surgery, chloroform is a particularly successful anaes- 
thetic, the excitement of war having the same counteracting 
effect. The danger in chloroform comes from giving it before 
pain is actually present, when the patient has not yet submitted 
to the operation, and probably is depressed with the thought of 
its approach. At first introduction, the greatest number of 
deaths resulted from patients in the dentist's chair. Hence 
there is proof that the condition of the nervous system has a 
great deal to do with the safety of chloroform, and when death 
is caused it is due to a nervous condition beyond our knowledge. 

The drawback to the use of both, but especially of ether, is 
that they produce vomiting; mauy things have been tried to pre- 
vent this, but so far without success, because vomiting itself is 
one of the disturbed nervous functions. 

It is the same with sea-sickness. No remedy has yet been 
found for this, and it almost exactly resembles the sickness pro- 
duced by the anaesthetics. There is the same deathly nausea, 
the same temporary relief on vomiting, followed again by in- 
tense nausea and great depression, which, as in sea-sickness, may 
last for many hours. Nothing will relieve it, but about the best 
thing to be done is to give brandy and water, and nothing more. 
The vomiting in ether is not only annoying to the surgeon, but 
is very dangerous, as, occurring while the patient is profoundly 
unconscious, it allows of the regurgitation of vomited matter 
into the trachea, in some cases this being the cause of secondary 
pneumonia, besides the immediate danger from suffocation; and 
it is particularly dangerous in operations about the head and 
face. The patient should be allowed no solid food for twenty- 
four hours before the operation, and particularly no oatmeal. 
He may take milk or beef tea, anything dilute that is sure of 



218 NOTES OX MATERIA MEDICA. 

being digested. The solid food would not be digested, because, 
owing to the dread of the coming operation, the digestion is 
suspended. 

In administering ether, the patient very soon begins to strug- 
gle, cough, etc., and one is tempted to let air in to relieve 
him, but this would only prolong the agony. The character 
of the respirations should be carefully noticed. The patient 
should be encouraged, so long as he is conscious, to inhale the 
ether as deeply as possible. He should be restrained so as to go 
through the state of excitement without injury to himself. As 
he gets well under the influence of the ether, he begins to snore, 
which is a good sign, so long as it is pharyngeal — the ordinary 
snoring of deep sleep, caused by relaxation of the soft palate 
and uvula. If instead of this it is laryngeal, stertorous, high- 
pitched, squeaky, croupous breathing caused by paralysis of the 
vocal cords, then the administration of ether should be sus- 
pended and air admitted, because now there is danger of 
asphyxia in two ways: First, by the ether paralyzing the vocal 
cords, epiglottis, etc., in which case the diaphragm ceases to 
act. When this happens, turn the patient over on the right 
side, and the breathing mechanism will resume its action. 

The other danger is that, when anaesthesia is complete, the 
sensation of the tongue is lost and it is consequently relaxed, and 
if the head is thrown back the tongue is crowded into the 
pharynx, and asphyxia produced by stopping up the air passages. 
The mouth should be open, the tongue brought forward, the 
patient turned on the right side, and breathing will be resumed. 
The sign by which to judge whether the patient is fully under 
the influence of ether is when sensitiveness of the conjunctivae 
is lost. 

With chloroform, all of these statements are equally applicable 
about respiration, but the pulse and countenance should be care- 
fully watched as well. The admission of air during the admin- 
istration of chloroform should never be completely shut off. 
When, from being flushed, the face becomes suddenly pale, it is 
a dangerous symptom, and notably when it occurs in the mucous 
membrane of the lips. Irregularity of the pulse indicates cardiac 
weakness, and the chloroform must be suspended. 



MEDICINAL REMEDIES. 219 

Irregular respirations of a shallow character are dangerous 
if repeated often, and should be treated in the same way. With 
these precautions, chloroform may be safely administered, es- 
pecially if taken well at the beginning; there is not much fear 
afterwards, death most often occurring at the beginning of its 
administration. 

Nitrous oxide is used quite extensively in dental practice and 
is very serviceable as an anaesthetic, provided the operation can 
be performed as quickly as the extraction of a tooth, the anaes- 
thesia being very brief and so not answering for any prolonged 
operation. 

VIII. Cocaine. 

This alkaloid is obtained from the leaves of the Coca erythroxy- 
lon. This medicine has obtained a wide range of popularity 
within a comparatively short period of time. 

Cocaine produces a localized anaesthesia when applied to the 
mucous membranes or the skin, and its action is decidedly 
marked in this respect, and extends more deeply when a hypo- 
dermatic injection is made into the submucous tissue. When 
painted over the skin, a sensation of warmth is at first experi- 
enced, to be followed in a few minutes by complete loss of sen- 
sation, the part becoming pale and anaemic. 

Cocaine acts upon the circulation in two ways: by constrict- 
ing the blood-vessels, and so increasing arterial pressure, while 
at the same time it stimulates the heart. The stimulating 
action upon the heart passes away, however, before the arterial 
contraction disappears. 

Cocaine possesses a marked mydriatic effect. This effect is 
perceived in from ten to twenty minutes after dropping the 
solution on the conjunctiva, and it reaches the maximum 
effect in half an hour, lasting for another half hour, and then 
slowly disappearing. The employment of the muriate of cocaine 
as an anaesthetic in ophthalmic practice is highly spoken of. A 
four-per-cent solution is dropped on the conjunctiva three or 
four times, at intervals of five minutes, when complete anaes- 
thesia follows. 

In examinations and operations about the larynx, cocaine is 



220 NOTES OX MATERIA MEDIC A. 

employed and with good results. A twenty-per-cent solution 
should be used in those cases. Tonsillitis is sometimes relieved 
by the use of a four-percent solution of the hydrochlorate of 
cocaine painted over the tonsils. It may be necessary to repeat 
the application every hour or so. Hay fever is sometimes greatly 
relieved and its paroxysms prevented by painting the mucous 
membrane of the nose with a twenty-per-cent solution. Epi- 
staxis is usually a trivial complaint, but may become dangerous 
when due to toxaemia and malarial diseases of the spleen and 
liver. In these cases, it cannot be arrested, from the fact that 
the veins in the turbinated bones lie in long cavities, and no 
pressure can be applied to them; the haemorrhage is best con- 
trolled by applying a two-per-cent solution of cocaine. It can 
he used to relieve the pain of fissure in ano, when the patient 
suffers for several hours after a movement of the bowels. Ifc is 
useful also in the treatment of haemorrhoids and ulcers about 
the anus. It has been used to relieve the pains of parturition, 
but must be injected into the submucous tissue. Upon the 
genito-urinary tract cocaine acts well. The injection of a few 
drops of a two-per-cent solution into the urethra relieves the 
pain and irritation of acute gonorrhoea. Sometimes it is extremely 
difficult to pass a sound into the urethra, owing to great sensi- 
tiveness, as in the case of stricture; the injection of a few drops 
of the four-per-cent solution can be tried. In irritable condi- 
tions of the bladder, an injection of the four-per-cent solution 
is useful. In neuralgia, the hypodermatic injection of one- 
third of a grain may be employed, and the injection should be 
made in the course of the affected nerve. 

IX. The Hypnotics. 
Chloral. 

Chloral itself is an oily liquid discovered in 1832. The addi- 
tion of water forms the hydrate, a salt with sharp taste and pos- 
sessed of very peculiar sedative properties. On addition of an 
alkali, the salt is decomposed and gives off chloroform ; hence 
the mistaken surmise that the action of chloral in the system 
was due to the chloroform elaborated from it. But the actions 



MEDICINAL EEMEDIES. 221 

of chloral, and those of chloroform administered internally, are 
not identical; chloral having no stimulant action, as the ethers 
and chloroform, but is a pure sedative. 

Chloral hydrate is one of the best hypnotics known, as the 
sleep which it causes resembles in all particulars that of nature. 
The patient, under its influence, drops quietly to sleep ; the 
respirations are rhythmical, the blood is perfectly oxygenized, 
and it is not followed by headache and nausea from slowness of 
the respirations and the accumulation in the blood of carbonic 
acid gas. The brain is perfectly rested by the sleep, as there is 
not hyperemia of the brain and a comatose state, as in the sleep 
by opium. 

On this account, chloral hydrate is a valuable remedy in 
cases of insomnia, a symptom which demands close attention; 
for if it is allowed to go on it may lead to grave results. 

It is indicated in cases of sleeplessness from anxiety and men- 
tal fatigue, and can, therefore, be used in mania and in patients 
with worn-out or anxious brain. Insomnia is one of the earliest 
and most persistent symptoms of insanity, and can often be 
traced back to care, grief, some sudden impression, as terror, or 
to other forms of mental shock. In this kind of insomnia, the 
mind is occupied with some train of thought which makes it 
difficult to fall asleep; and when asleep the dreams are on one 
subject. The brain, remaining active, has no rest and will wear 
itself out. As a result, there is destruction of the red blood- 
corpuscles, loss of bodily weight, hallucinations with a tendency 
to suicide, homicide, or epilepsy ; and on autopsy, meningeal 
inflammation from excess of circulation will be found. Sleep- 
lessness of this variety becomes dangerous when accompanied by 
depression of spirits, despondency, and melancholia, for these 
are symptoms of approaching insanity. With the depression of 
spirits there may be fixedness of the eye. There may be an effort 
on the part of the patient to throw friends off their guard by 
feigning cheerfulness. In this form of insomnia, chloral is the 
great remedy. The hypnotic must be persevered in till the pa- 
tient has had five or six nights of uninterrupted artificial sleep. 
There will be less likelihood of the chloral habit or dependence 
on hypnotics when given in this way than with the usual irregu- 



222 ^"otes o:n" materia medica. 

lar and occasional administration. After a week of artificial 
sleep, the patient will probably sleep naturally. 

The dose is from gr. x.-xv. for producing sleep. To reduce 
reflex excitability producing insomnia, use it as an adjuvant to 
potassium bromide; add gr. viij. to each dose of the bromide 
in case of epilepsy. Also add small dose of the chloral in irrita- 
tive coughs, as it promotes the action of medicines that allay the 
irritation producing cough. 

So far so good. But every now and then, for reasons beyond 
our knowledge, chloral is fatal. When dangerous symptoms 
appear, it is extremely difficult to save the patient's life. The 
use of stimulants, electricity, etc. , will rouse him out of the dan- 
gerous state, but he will relapse into it again continually. Never, 
on that account, begin with more than gr. x., for a number of 
deaths have been recorded from gr. xv., and two deaths from 
gr. x. doses; but usually the latter is a safe dose to begin with, 
and then, if symptoms are not produced, it may be increased to 
gr. xv. or xx., but the peculiarity of its persistent action indi- 
cates that there should be some considerable time between the 
doses. The dose should not be repeated under two hours' inter- 
val. Some patients can take gr. xxx. very well indeed; but do 
not begin with that. As an anaesthetic, its properties are not 
very well marked until added to other remedies. 

Paraldehyd. 

Paraldehyd is a medicine used only for producing sleep. It 
has a vile taste and is difficult to give on this account, and, more- 
over, it has to be given in large doses, from fit xxx.-xl. The 
taste may be covered by syrup of ginger. It is a moderate 
hypnotic and' a good one, particularly useful in insomnia from 
mental causes, not so useful in insomnia due to peptic causes — 
fermentation in stomach and intestines. The difference between 
these two forms of insomnia is that in nervous insomnia the 
difficulty is in getting to sleep; in the other form, in remaining 
asleep. 



MEDICINAL REMEDIES. 223 

Sulfonal. 

This is a medicine not found in nature, but made artificially 
by the chemist. Chemically it belongs to the group disul- 
phones. 

Sulfonal is a whitish, crystalline substance, without odor or 
taste, very slightly soluble in cold water, more so in warm water, 
and still more in alcohol, ether, etc. It is a pure hypnotic, 
neither anaesthetic nor depressing in character, and it does not 
affect the heart or circulation, and the sleep it produces is per- 
fect. Being quite insoluble, it requires about three hours to be- 
come thoroughly dissolved in the stomach, and should be given 
about two hours before bedtime. As it is not affected by the di- 
gestive secretions, it may be given shortly after the evening meaL 

Sulfonal is of great value in the insomnia of the insane, and 
the dose should be repeated once during the night if the sleep is 
too short. It is specially recommended in cases of nervous in- 
somnia, also in the sleeplessness of delirium tremens. In the 
latter case, gr. xx. should be given every two hours until sixty 
or eighty grains have been taken, but it should be remembered 
that every case of delirium tremens is also a case of starvation, 
and to produce good sleep the patient must be fed. 

The usual dose of sulfonal as a hypnotic is gr. xv.-xx., and 
should be given in capsules. 

Phenacetin. 1 

The number of remedial agents drawn from the carbolic-acid 
series seems to increase day by day. From this source we have 
not only obtained powerful antiseptics and active antipyretics, 
but more recently anodynes which, in some conditions, rival 
those furnished by the vegetable alkaloids. To the carbolic- and 
salicylic-acid classes are added antipyrine and acetanilid, and 
these are now increased by the addition of the phenacetins. 

Phenacetin is a white, glossy, crystalline powder, being per- 
fectly tasteless. It is freely soluble in alcohol, but only slightly 
so in water. It has a double action: it lowers the temperature 

1 Phenacetin is not a hypnotic. It is derived from the carbolic-add series, 
And has actions similar to antipyrine, acetanilid, etc. — Ed. 



224 NOTES ON MATERIA MEDIC A. 

and relieves pain. As an anodyne, it is superior to antipyrine 
and antifebrin. 

It can be used in neuralgia, migraine, muscular rheumatism, 
acute articular rheumatism, and the lightning pains of locomotor 
ataxia. In some cases of hysteria and of hysterical or neurotic 
pains, phenacetin seems to act as well as the bromides; it quiets 
irritable conditions of the nervous system, and in some cases in- 
duces sleep. 

As an anodyne, the dose should not exceed gr. vij., and, if 
necessary, this dose may be repeated after three hours. The 
dose necessary to produce a decided reduction of the tempera- 
ture m fevers is, on the average, gr. xx., and this can be divided 
into two parts, and each dose given in the interval of one or two 
hours. 

For the reduction of the temperature in fevers, however, the 
external application of cold is to be preferred to any one of the 
internal antipyretics. 

Division II. — Eliminatives or Glandular Medicines. 

These medicines increase gland secretion, and are given more 
against complications occurring in the course of acute or of 
chronic diseases than against mere symptoms. Thus the high 
temperature of febrile conditions arrests secretion generally, 
and where this is long continued, life will be further endangered 
in these diseases by the complication of starvation, from the de- 
ficiency of the digestive secretions in the alimentary caual, and 
by the complication of self poisoning from retained excretions. 
If the fever be lowered and the glands supplied with blood at 
the normal temperature, they will at once resume their func- 
tions; but, until this is done, eliminatives are meanwhile useful, 
not to eliminate the disease, but to modify the complications. 
In those non-febrile conditions of the system where the arrest 
of secretions is not general, as in fevers, but local, the elimina- 
tive class of medicines is also useful, as by them the different 
gland secretions are sometimes made to act vicariously for some 
one deficient gland function, as when cathartics and diaphoretics 
are used in kidnev disease. 



MEDICINAL REMEDIES. 225 

The eliminatives are divided into: 

1. Cathartics, which increase the secretions of the intestines. 

2. Emetics, which act upon the secretions of the pharynx, 
stomach, liver, and duodenum in the act of emesis. 

3. Diuretics, which act on the kidneys. 

4. Diaphoretics, which act on the skin. 

5. Expectorants, which act on the bronchial secretion. 

1. Cathartics. 

Cathartics are those remedies which increase the secretion of 
the intestines. The use of cathartics is indicated by two en- 
tirely different conditions: (1) in diarrhoea due to local intesti- 
nal inflammation; (2) in constipation. 

Constipation. — This condition, when not dependent on some gynecological 
ailment, is generally due either to deficient action of the small intestine or 
to deficient action of some part of the large intestine. 

Deficient action on the part of the small intestine is due to two causes: 

1. Deficient secretion. 

2. Want of innervation, or want of muscular action. 

Constipation dependent upon deficient secretion is quite distinct from that 
caused by want of muscular action, but in many cases both causes will be 
operating. 

Deficient secretion in the small intestine may be caused by some disturb- 
ance of the liver. Constipation, therefore, may date from the time when 
the patient suffered from some severe form of fever in which the liver was 
prominently involved, such as the bilious remittent ; or it may follow an 
attack of tropical diarrhoea, which is almost invariably accompanied by 
marked hepatic disturbance. 

In such cases, the patient does not have an extraordinary fecal accumula- 
tion and impaction, but there is, instead, a sluggish action of the bowels, and 
he is usually obliged to take medicine to bring about a movement once in 
four or five days ; and when it does occur, the evacuation is moderate in 
amount and quite dry. 

This kind of constipation is quite common in the Southern States as a 
sequence of the diarrhoea which prevails in that latitude ; and it is also fre- 
quently seen in the Northern States as the result of malarial poisoning. 

The symptoms are extremely negative, except the constipation. The one 
which perhaps gives the patient most discomfort is a tendency to a dull, 
indefinite headache. In a majority of cases, this is located in the posterior 
part of the head, is rather an uncomfortable sensation than a real pain, and 
is best relieved by something which promotes a free discharge of bile. The 
!5 



226 NOTES OX MATERIA MEDICA. 

tongue usually is small, not large and flabby, generally a little reddened 
along the edges and tip, and the secretions of the mouth are commonly vis- 
cid. The condition of the mouth is an indication of the condition present 
along the entire alimentary canal. We have, therefore, evidence of the 
presence of only a moderate amount of secretion in the intestinal tube, and 
our treatment should be regulated accordingly. 

If, for the relief of this condition, mild cathartics be administered, the 
condition of the case will be aggravated, because the temporary stimulus 
afforded by them, however mild, is immediately overcome by the tendency 
to deficient secretion. Active purgation produces a much more injurious 
effect than mild laxatives. If resort be had to the use of medicines which 
have been recommended to stimulate nerve action, not much benefit will be 
obtained. What should be present in the intestine is a small increase of 
lubricating substances, as it were, and to that end altogether the best results 
have been obtained by causing the patient to take a great deal more water 
than is his usual custom. Let him take, on rising in the morning, two tum- 
blerfuls of drinking-water. As a rule, those who drink considerable water 
are not troubled with constipation. The laxative action of the water can be 
insured by the addition of some mild saline, like the carbonate of soda, or 
even common salt, and the reason why such an effect is produced is this : 
the mixture formed by the union of some saline with water does not readily 
pass through the mucous membrane, and so into the general system. The 
theory now generally accepted with regard to the action of salines is that 
they are not absorbed, and that they prevent the water with which they are 
combined from being absorbed ; hence the water, by exciting the peristaltic 
action of the bowel, brings about a movement to discharge it, and with that 
the other contents of the intestinal tube. There is considerable to lend sup- 
port to this view. It is not necessary to give large doses of saline cathartics, 
as a half-drachm of the sulphate of magnesia, dissolved in a pint of water, 
commonly operates very nicely. 

There is another fact which may here be mentioned, namely, the addition 
of small doses of quinine to salines increases their power of acting upon the 
intestine. For example : 

^ Magnesii Sulphatis, . . . . . 3 i. 

Quininse Sulphatis, .... . gr. i. 

mixed and taken in a tumbler of water every morning, rarely fails to pro- 
duce all the laxative effect required in every form of deficient secretion 
from the bowels ; for instance, in the constipation following fever, when 
you desire to obtain a free alvine evacuation. 

It is well to tell the patients that they will not, perhaps, see much effect 
for one or two weeks ; but if they can be induced to persist in the daily use of 
large quantities of water, a great deal of benefit will almost certainly follow. 
There is a supposition on the part of the laity that certain fruits are laxative, 
and that is probably true to a limited extent. Oranges may be eaten with ben. 



MEDICINAL REMEDIES. 22? 

efit, but it usually requires ten or twelve to overcome an obstinate constipa- 
tion, a fact which renders the remedy quite impracticable in this climate. In 
the warmer climates, however, the worst forms of constipation which appear 
can be overcome by oranges alone; and the more juicy they are the better, 
from the fact that the citric acid which they contain has a tendency to pro- 
duce a catarrh of the intestine if taken in excess. Figs are a rather danger- 
ous laxative, for they may obstruct the intestines ; there is not much danger, 
however, in this direction, if taken with a large quantity of water. It will 
be found necessary to use about double the amount of water with figs that 
will be required with any other laxative fruit. The fruits of this climate 
are very uncertain in their action ; the action of apples is very good, but 
very many persons are unable to take them in sufficient quantity to produce 
any effect upon the bowels, although they may at the same time take a large 
quantity of water. All along it will be found that water is one of the most 
important agents to be employed for overcoming deficient secretion in the 
intestine attending constipation. If flatulence, resulting from decomposi- 
tion of the intestinal secretion, accompanies the constipation, recourse may 
be had to the following pill : 

R Asafoetidse, gr. iv. 

Saponis, gr. ix. 

M. 

To this may be added nux vomica, if there is evidence of deficient innerva- 
tion in the intestine. 

How are we to judge that the leading element in the case is deficient in- 
nervation, especially with reference to the small intestine ? As a rule, 
deficient innervation is an accompaniment of the constipation that troubles 
persons with sedentary habits of life. 

As a rule, it attends the constipation present in elderly persons and such 
constipation also occurs among those whose occupation causes them to main- 
tain positions in which the abdominal muscles are to a very great extent 
motionless, such as shoemakers, tailors, etc. There is also a tendency to 
headache, and there is a great deficiency in the excretion of the coloring 
matters of the bile, as might be expected ; for the secretory action of the 
intestines is as much interfered with as is the muscular action. Hence this 
class of patients are usually of dull, sallow color ; there is a tendency to 
greasy accumulations upon the surface ; the entire movements are sluggish, 
and there is usually. a lack of frequency in the pulse. 

Now, with regard to the treatment for this class of cases, in the first 
place the habits of the patient have a tendency to keep up the constipation, 
but the means to be employed for overcoming it are quite different from 
those resorted to in the other class. As a rule, these patients do not bear 
much water, because it weakens their digestive powers, and they will very 
soon complain of loss of appetite, heaviness in the head, etc., and it does 



228 NOTES ON MATERIA MEDICA. 

not excite much peristaltic action in the bowels. At all events, it is not. 
nearly so apt to increase the peristaltic action as in the class of cases in 
which deficiency of secretion in the intestinal canal is the leading element. 

What should be done here is to arouse the peristaltic action of the bowels, 
and at the same time increase the general innervation of the secretory appa- 
ratus. To do this, the best means that can be employed, if the patient is 
permitted to remain at his occupation, is water applied externally. The 
only way in which they can derive benefit from the internal use of water is 
to send them away from their business to a mineral spring. Then, having 
a change of occupation, the water taken internally will give them much 
benefit. But most patients will be unable to make this change, and for 
these water may be used externally with great advantage. Direct that a 
sitz bath be taken every night in water as cold as the patient can bear, 
and have a good reaction afterwards. In a great many cases, this simple 
measure will work wonders, just as it will do in certain cases of deficient 
innervation of the large intestine. 

Another method of using water externally is, on rising in the morning, to 
sponge the spine and bowels with cold salt water, made about as irritant as 
possible. In other cases, great benefit will be derived by giving the bowels 
a local shower-bath, and that can be done by dashing the water against the 
abdomen while the patient is in the standing position. This brings about 
an action in the bowels, the same as a cold hand upon the abdomen causes 
contraction of the uterus ; that is, it is through the sympathy of the nerves 
of the surface with the viscera underlying them. In this class of cases, nux 
vomica has proved itself a very efficient remedy, and it may be administered 
in combination with any other drug. It will increase the efficacy of small 
doses of the resinous cathartics, which are irritant and stimulant ; hence 
small doses of rhubarb with nux vomica and soap may be given in the form 
of a pill with much more benefit than when administered separately. 

The application of the faradic current, one pole of the battery placed over 
the spine, and the other passed up and down over the abdominal walls, will, 
in many cases, be found beneficial. 

What is known as the health-lift will prove advantageous in certain cases, 
and the reason is that it brings into action all the abdominal muscles, espe- 
cially the recti, and that action is brought to bear directly upon the sluggish 
intestines. When any lesion of the bowels is present, the health-lift cannot 
be employed. 

In the constipation dependent upon diabetes, due to total deficiency of secre- 
tion into the intestinal tube, death may result in consequence of the consti- 
pation which occurs in connection with this disease. 

Constipation Dependent upon Certain Conditions Present in the Large 
Intestine. — In the large intestine, we find that constipation depends upon 
nearly the same conditions as were found present in the small intestine. 
That is, we have constipation dependent upon deficiency of action, and that 



MEDICINAL REMEDIES. 229 

it in turn may depend upon deficient secretion or deficient innervation, but it 
is far more commonly dependent upon the latter. Here the patient may be 
troubled with large faecal accumulations, and that condition may depend 
upon deficient nerve power on the part of the colon, or the deficient inner- 
vation may be confined to the rectum. 

One of the worst forms of constipation may occur, dependent upon no 
other condition than that which is present in the rectum alone, and, unless 
the physician is upon the alert, the result may be the development of a rectal 
abscess. 

When this condition is present, the patients have but little knowledge that 
they should have a movement from the bowels, and whenever the sensation 
is developed they have little or no power to expel the faecal accumulation. 
When such symptoms are present, it is a pretty certain indication that they 
depend upon deficient innervation of the rectum, and, unless that condition 
is overcome, serious consequences may follow. One of the most common 
causes of this condition is a chronic inflammation set up about haemorrhoids. 
Prolonged inflammation of any part, especially, however, about the mucous 
membrane, produces deficient innervation, and then follows a relaxed con- 
dition, and with this deficient innervation we are, therefore, very liable to 
have prolapsus of the rectum. 

These patients are peculiar in one respect, namely, they are generally very 
low-spirited. It sometimes happens that insanity is developed by such a 
diseased condition of the rectum, and is relieved when the rectal trouble is 
removed. 

With regard to treatment, the first indication is to keep the rectum empty. 
When faecal accumulations are present, the most efficient and convenient 
method of removing them is by means of enemata, but caution must be 
used in resorting to this measure. Never prescribe* enemata as a regular 
treatment, for if the patient gets into the way of emptying the bowels daily 
in health by enemata, he can never dispense with their use. If the patient 
should use the syringe every morning for the purpose of evacuating the 
bowels, and it is continued regularly for six weeks, he has gone considerably 
far towards making it a necessity during the remainder of his life. This 
measure should not be used unless absolutely necessary. 

Within recent years, glycerin has been largely used as an enema, and in a 
certain proportion of cases it answers admirably; a retained injection ( 3 i - 
ij.) producing very free movements in from five to twenty minutes, gen- 
erally unaccompanied by any pain. Glycerin suppositories are now made, 
and are claimed to be superior to an enema. Glycerin seems to act best 
when the rectum is loaded from faecal accumulations in the descending 
colon. It has been used extensively in Europe for the constipation of 
infants (gtt. xx.). Occasionally it has produced some irritation of the 
rectum, but in the great majority of cases the constipation has been re- 
lieved promptly. In cases where the intestine is obstructed in adults, an 



230 NOTES OX MATERIA MEDICA. 

enema should be tried (dose, 1 ss.) It will probably be necessary to use 
enemata for removing accumulations which happen to be present, but when 
they are thoroughly cleared out resort should at once be had to other mea- 
sures for restoring lost innervation to the bowel, and one of the very best of 
these is the local use of strychnia It is an exceedingly valuable specific in 
these cases. It will frequently succeed in curing the worst forms of pro- 
lapsus of the rectum, as well as that condition in which there is simple 
debility with hypertrophy of the mucous membrane. The manner in which 
you can cure long-standing cases of prolapsus of the rectum by means of 
injections of strychnia into the submucous tissue itself is sometimes wonder- 
ful. If necessary, a fold of the mucous membrane can be drawn down and 
the injection then inserted. 

This agent may be relied upon almost exclusively in the treatment of this 
class of cases, whether the real cause was hypertrophy of the mucous mem- 
brane from long-standing haemorrhoids, or there was a simple deficiency of 
power in the rectum to expel its contents. There is another class of cases 
in which this agent will prove beneficial, and that is cases of prolonged 
cystitis from any cause. As is well known, elderly men who suffer from 
enlarged prostate, suffer more or less from cystitis, and they are always apt 
to have accumulation of faecal matter in the lower part of the bowel, and it 
is for the reason to which reference has just been made, namely, deficient 
innervation. Hence in the treatment of any form of cystitis, especially that 
accompanying enlarged prostate, if the patient complains that the evacua- 
tion from the bowels is small and that the movement does not seem to com- 
pletely empty them, clear them out effectually by means of enemata, and 
then use injections of strychnia, and you will find that, in very many cases 
both conditions will be materially relieved. With the other form of consti- 
pation there is a tendency to the formation of scybalous masses. The most 
common situation of such accumulations is at the upper part of the rectum, 
and next in the transverse colon. It is only when they are dislodged that 
they come down into the sigmoid flexure. It is in these cases that the mineral 
waters will be found most beneficial of anything that can be employed. In 
the first place, the mineral water will loosen the scybalous masses without 
depressing the patient in the least, and it will also prevent new accumula- 
tions. Of these, the Congress or Kissingen may be used, or both may be 
used at the same time. In this class of cases, considerable benefit will be 
derived from the use of belladonna or stramonium in the form of a suppos- 
itory. The patient may take his Kissingen water in the morning, and use a 
suppository of belladonna or stramonium at night. If the belladonna is 
employed, it should be given in such quantity as will produce a little dry- 
ness of the throat and slight dilatation of the pupil the following morning. 

Faradization along the track of the colon is equally beneficial as in the 
treatment of constipation of the small intestine; and the hip bath may also 
be of service, but it does not answer so good a purpose as when the small 



MEDICINAL KEAIEDIES. 231 

intestine is chiefly involved. If possible, the use of enemata should be 
avoided except for the purpose of removing faecal accumulation near the 
anus, for the effect produced by much overdistention of the intestine is 
bad. A single overdistention of the bladder may be followed by a perma- 
nent weakness for the remainder of the patient's life, and that distention 
may not last more than eighteen hours. So a single overdistention of the 
intestine may greatly weaken the normal rhythm of that tube. 

Constipation and Fcecal Accumulations following Febrile Diseases. — The 
effect of fever is to dry up all the secretions present in the intestine; conse- 
quently a very common complication when a patient is making a recovery 
from pneumonia or any other disease in which fever has been a leading ele- 
ment, is an accumulation of faeces at different parts of the intestinal tube. 

In former days, when fevers were treated upon the plan of administering 
medicines which were to eliminate the poison from the system by way of 
the bowels, scybalous accumulation did not occur very frequently; but 
nowadays, when the treatment is conducted upon an entirely different plan, 
the fever may be continued and retained as the direct result of faecal accu- 
mulation. This is especially true of the latter stages of a fever; but such 
accumulation can be prevented from forming, and be removed by the use 
of a proper kind of cathartic. For this purpose there is no combination 
more serviceable than the compound jalap powder, and it is the one which 
by all means should be employed. It promotes the discharge of the serous 
elements into the intestine, assists in the absorption of the deposits which 
have taken place in the lung, if the case be one of pneumonia, acts upon 
the kidneys as well as upon the bowels, and is one of the mildest cathartics 
that can be employed, which so fully meets the indications in this class of 
cases. 

Constipation Due to Great Deficiency of Biliary Secretions. — In this form 
of constipation, there are sallownessand greasiness of the skin. Compound 
Licorice Powder, formed of Senna, 18 parts; Licorice, 16 parts; Fennel 
Seeds, 8 parts; Washed Sulphur, 8 parts; Refined Sugar, 50 parts, should 
be given as a laxative (dose 3 i.— Ij .)- This powder is also very beneficial 
where there is irritation of the rectum, and should be the laxative wherever 
there is a tendency to hcemorrhoids. 

Nervous Constipation of Women. — In the female sex, constipation is some- 
times due to suppression of the peristaltic movements of the intestine by 
reflex irritation of the ovarian plexus, which will also cause cold feet, the 
irritation contracting the arteries of the legs, and there will be aching in the 
back. Warming the feet artificially, and giving belladonna, with a small 
dose of extract of colocynth, ' will often relieve the whole trouble. 

In administering cathartics, the following facts are to be 
remembered: 

1 For prescription, see page 181. 



232 2ST0TES OX MATERIA MEDIC A. 

1st. All cathartics operate better when in combination with 
each other, or with some other medicine, than when given 
alone. By combining small doses of several cathartics, the par- 
ticular action of each can be secured without the undesirable 
qualities of any, and this combination is therefore practically a 
new medicine. 

2d. Quinine and the mydriatics assist them in their action; 
quinine especially increasing the power of the sulphate of mag- 
nesium. 

3d. All saline cathartics must be taken very cold or very hot, 
as their action depends on their affecting the stomach. 

Cathartics may be divided into the following classes: 

(a) Cathartics which stimulate natural secretions. 

(b) Irritant or drastic cathartics. 

(c) Saline cathartics. 

(a) Cathartics that Increase the Natural Secretions. 

Calomel. 

Calomel is the cathartic for fevers when the constipation is 
due to the arrest of the normal secretions by the high tempe- 
rature, so that the stomach is wholly unable to digest solid 
food from the absence of the digestive secretions, and there 
is the serious danger, in all fevers lasting more than four- 
teen days, of the patient being virtually starved. A dry skin 
and intense thirst are present, and, owing to the scanty flow of 
urine, materials which ought to be excreted are retained, and 
there is the further danger of self-poisoning. Calomel, there- 
fore, should be given as a cathartic at the commencement of 
every fever, as it stimulates in a natural way the secretions of 
the intestines,' and thus diminishes the danger of starvation; 
and, being also a diuretic, it increases the flow of urine and 
diminishes the danger of self-poisoning from retained excre- 
tions. In addition to this, it will be found that in every fever, 
after the calomel has operated, the temperature is lowered, the 
skin becomes moist, and the intense thirst which invariably 
accompanies a dry skin is relieved. It has been demonstrated 
that typhoid fever runs a much better course if a calomel purge 



MEDICINAL REMEDIES. 233 

is given at its commencement. It is supposed that the retained 
excretions early vitiate the blood and afford a fruitful soil for 
the reproduction of the morbific germs of the disease. 

Calomel as a cathartic should always be given in large doses, 
as the effect does not vary much with the dose. When given 
alone, it acts in about twelve hours, but its action is hastened 
when combined with other cathartics, especially jalap and cream 
of tartar. Calomel is also valuable as a cathartic where the 
secretion of bile is deficient from congestion of the liver or other 
functional causes. A good formula for biliousness is: 

5 Pil. Hydrargyri, gr. iv. 

Sodii Bicarbonatis, 

Pulv. Rhei, aa gr. viij. 

Pulv. Aloes, gr. ij. 

Quimnae Sulphatis, gr. iij. 

M. Fiant capsul. No. iii. Sig. Take at one dose. 

In cases of lumbago and other forms of muscular rheumatism, 
with acid urine of high specific gravity, a cathartic of blue 
pill (gr. v.) with ipecac and soda is the best mode of treat- 
ment. Scrofulous children are often troubled with loss or per- 
version of the appetite, associated with constipation, with light 
or clay-colored stools, showing a deficiency of bile. These cases 
are greatly benefited by the use of some mild mercurial cathar- 
tic, as two or three grains of the hydrargyrum cum creta, com- 
bined with rhubarb and soda. This should be given three times 
a week for two or three weeks. 

Castor Oil (Oleum Eicini). 

This oil is expressed from the seeds of the Ricinus communis, 
a plant the best varieties of which grow in warm climates free 
from frost. The " cold drawn M castor oil is to be preferred, as 
this method of preparation eliminates an acrid principle, very 
irritating and poisonous, contained in the outer coat of the seed. 
The effect of oils in general, when applied to mucous mem- 
branes, is to produce a non-albuminous, watery flow until every 
particle of the oil has been washed away; and it is probably due 
to this action, and to its stimulation of the peristaltic .move- 



234 IKTOTES ON MATERIA MEDIC A. 

ments of the intestines, that castor oil owes its cathartic prop- 
erties. It has not, however, a local action upon the intestines 
alone, for, after it has been absorbed into the blood, it produces 
the same effects elsewhere. This has its advantages and disad- 
vantages, for castor oil given to a nursing woman will some- 
times purge the infant, but at the same time it stimulates the 
secretion of milk. (A fomentation of the leaves of the plant, 
or castor oil itself, applied to the breast, is often used for this 
purpose.) Castor oil, therefore, should not be given where 
these effects are not desired, nor should it be given to children 
with capillary bronchitis ; for, acting upon the same principle, 
it stimulates the secretion of mucus in the bronchial tubes — the 
very thing to be avoided, as, owing to the feeble expectorant 
powers of children, this disease is very dangerous, and one of 
the commonest causes of death among them. (These cases may 
often be successfully treated by giving 3 ss. doses of hot milk 
and lime water, which strengthens the heart and assists expecto- 
ration by taking advantage of the vaso-motor nervous associa- 
tion existing between the oesophagus on the one hand and the 
trachea and bronchial tubes on the other.) 

Castor oil is a very good cathartic for the faecal accumula- 
tions, or constipation with dry, hard faeces, occurring in many 
febrile diseases of short duration. Where the fever is prolonged, 
calomel is the best cathartic; but where, as in malarial fever, it 
lasts only for a day or two, castor oil, besides its beneficial 
cathartic action, is also effective in rapidly lowering the tem- 
perature. 

It is the remedy to begin with in the treatment of the dysen- 
tery of temperate climates, 1 a disorder not uncommonly due to 
the retention of hard faecal matter. After the bowels have been 
cleared, the treatment should be castor oil 3 i., and laudanum 
gtt. x., given every three hours. This combination has a bene- 
ficial soporific effect not produced by the laudanum given alone. 
Castor oil is indicated in all cases where there are stringy mucus, 
blood, etc., in the faeces. As a rule, it is a prompt cathartic, 



1 For the treatment of the dysenteries prevalent in hot climates, see 
page 247. 



MEDICINAL REMEDIES. 235 

producing movements within half an hour after administration; 
but in some cases they will not take place for four hours, or 
even longer (dose, 3SS.-L). 

Aloes and Rhubarb. 

These are excitants of the natural secretions, par excellence, 
and the only ones to be recommended for this purpose. There- 
fore, in all cases where, from absence of the digestive secretions, 
there is intestinal catarrh or imperfect action of the liver, with 
sallowness of skin, loss of appetite, and sluggish, irregular 
action of the bowels, or mal-digestion with consequent disor- 
ders, the first and foremost of which is summer diarrhoea, these 
cathartics are the ones indicated, as they restore the digestive 
powers, improve the appetite, etc., and may be given for 
months together without any harmful results; whereas other 
cathartics, if their use was so long continued, would certainly 
cause a great deal of weakness if not serious intestinal derange- 
ment. Many of the symptoms of chronic dysentery will also be 
relieved by the daily administration, week after week, of rhu- 
barb or aloes. 

Aloes. — This substance is the inspissated juice of the leaves 
of the Aloe Socotrina and other species of aloes growing in warm 
climates. The best varieties come from Mozambique. It is a 
greenish -black substance, breaks with a smooth, glassy fracture, 
and has an aromatic odor. It contains a crystalline principle 
called aloin (dose, gr. T V-i )• Aloes is a slow cathartic, 
requiring from twelve to eighteen hours before it operates, 
and, if given alone, causes considerable griping. Hence it is 
often necessary to combine it with other cathartics, and it acts 
best when in combination with rhubarb in the compound rhu- 
barb pill (Pulv. Ehei, gr. ij.; Pulv. Aloe, gr. iss. ; dose, two 
to five pills). The movement produced by it is not watery, 
showing that it relieves the system of faecal accumulations. 
Many ailments, especially those of young women, are due to 
such accumulations, the patients sometimes not having a move- 
ment for several days. For this condition, and for offensive 
breath dependent on intestinal disorders, aloes and rhubarb in 



236 NOTES OX MATERIA 3IEDICA. 

the form of pills, with the administration of nitro-muriatic 
acid, is the most successful treatment. An old prescription, 
and a very good one, for stimulating the sluggish digestion of 
chlorotic women, was tincture of aloes and myrrh. (This mix- 
ture is intensely bitter, and is now put up in pill form.) Given 
with iron in chlorosis, this mixture answers admirably, as it 
improves the appetite, overcomes the constipation, and pro- 
motes the assimilation of the iron. Aloes also stimulates the 
circulation of the pelvic viscera, and acts upon the uterus as an 
^mmenagogue. It is, therefore, indicated in amenorrhea, dys- 
menorrhea, also in chronic constipation, in piles which are not 
inflamed, in prolapsus of the rectum not due to recent inflam- 
mation, and in enlarged prostate from sluggish circulation. It 
is contra-indicated when inflamed hemorrhoids are present; 
also in pregnancy, cystitis, and in inflammatory conditions of 
the pelvic organs. 

The dose of the powdered aloes is ten grains, but if given 
twice a day, five grains. As it accumulates in the system, the 
doses should be smaller still if its use is to be continued for any 
length of time. A saline drink should be given six hours after 
its administration, or in the morning when the aloes is given at 
night on retiring. 

Rhubarb (Rheum). — This resinous cathartic is prepared 
from the root of several species of Eheum growing in elevated 
regions of Central Asia. By virtue of a kind of tannic acid 
contained in the root, rhubarb possesses astringent as well as 
purgative properties. Rhubarb, as a cathartic, stimulates the 
intestinal movements and produces a slow, griping movement 
in from six to eight hours. This is followed by increased appe- 
tite and a tendency to constipation, the tannic acid operating 
after the cathartic action has ceased. Combined with an alkali, 
rhubarb makes a sort of emulsion which, in its constituents and 
properties, closely resembles human bile, less some of its salts. 
Besides its other properties, it is, therefore, both antiseptic and 
restorative. Hence rhubarb is the typical cathartic for the 
common summer diarrhea due to intestinal fermentation, es- 
pecially when it occurs in children. For the purpose of pre- 



MEDICINAL REMEDIES. 237 

venting the griping action of both rhubarb and aloes, we 
combine other substances with them. The alkalies are the best 
for this purpose, as they do not cause constipation and promote 
the action of the cathartics. The bicarbonate of soda and mag- 
nesium sulphate are the substances generally used. Soap has 
the same effect as the alkalies, but not to the same degree. All 
spices will counteract griping, but they cause constipation. 
As, however, we want this effect in treating diarrhoea, the 
aromatic tincture of rhubarb is commonly prescribed for this 
disorder. 

For the treatment of summer diarrhcea of adults, the follow- 
ing is a good prescription: 

3 Magnesii Sulphatis, 3 iv. 

Tr. Rhei, 3 vi. 

Syr, Zingiberis § iss. 

Aquae Menthae Piperitae, ad % vi. 

M. Sig. Tablespoonful every three hours. 
For a child one year old or under: 

$ Tr. Rhei 3 ij. 

Magnesii Sulphatis, 3 i. 

Syr Zingiberis, 3 iv. 

Aquae Menthae Piperitae, ad § iss. 

M. Sig. Teaspoonful every two or three hours until the 
diarrhcea is stopped. 

Opium should not be used, as it aggravates the original cause 
by suspending the natural secretions, but it may be necessary 
to give it where there is inflammat'on, and in violent peristaltic 
movements it may be necessary to use it. 

Cascara Sagrada. 

This drug is the dried bark of the Rhamnus Purshiana, a 
tree growing on the North Pacific coast. A very bitter fluid 
extract is made from it. In small doses it acts as a tonic, im- 
proving the appetite, etc.; in larger doses it is a mild cathartic. 
For offensive breath caused by intestinal disorders, this sub- 
stance is an excellent remedy if the patient is not troubled 



238 NOTES ON MATERIA MEDICA. 

with hemorrhoids. Give five drops of the fluid extract three 
times a day, as it operates better in this way than if given in 
one dose. 

(b) Irritant Cathartics, or Drastics. 

The drugs which form this class are all vegetable cathartics, 
and contain resinous and acrid principles in such a degree that 
in large doses they produce severe if not fatal gastric irritation and 
inflammation. Their operation is accompanied by more griping 
than that of other cathartics, and the violent purgation often 
produces faintness; but where prompt and free action is desired, 
recourse must be had to them. If small doses of several of 
these cathartics are combined, it prevents the too great activity 
of any one of them acting singly. 

Colocynth 

Is the dried pulp of the Citrullus colocynthis, a bitter cucumber 
growing on the southern and eastern shores of the Mediterranean 
Sea. When fully developed, it is a gourd about the size of a 
large orange. The part used in medicine is the pulp surround- 
ing the seeds, and is intensely bitter and irritating to the eyes. 
It contains an active principle called colocynthm. 

When given alone, even in small doses, it produces intense 
inflammation of the duodenum and of the biliary and pancreatic 
ducts, with a profuse flow of serum. Its action may be so 
violent as to produce fatal g astro-enteritis. It is never used 
alone, but as an addition to the laxatives where it is desired 
to unload the bowels or to deplete the portal circulation. It 
should never be used where there is dropsical effusion. 

It is an active constituent of Brandreth's pills, and the chief 
ingredient of most quack pills. The administration of three of 
the compound cathartic pills of the TJ. S. Pharmacopoeia (which 
contain colocynth) is an excellent preparatory step to the ex- 
hibition of quinine in malaria. For chronic constipation of 
women, this drug, with belladonna, etc., is superior to calomel. 



MEDICINAL REMEDIES. 239 

Scammony. 

This substance is the resinous exudation from the root of the 
Convolvulus Scammonia, a vine growing in Arabia and Syria. 
It is an extremely powerful cathartic, resembling colocynth in 
its physiological action. It is generally used in combination 
with other drugs. 

Jalap. 

Jalap is the tuberous root of the Exogonium purga, and is 
named from the town of Xalapa, in Mexico, of which country 
the plant is indigenous. It is the mildest in its action and the 
least irritating of all the resinous vegetable cathartics, producing 
a prompt watery flow from the small intestines. On this ac- 
count it is especially useful for unloading the portal circulation. 
A very good combination for this purpose is jalap ten grains, 
and calomel ten grains, as each drug assists the action of the 
other, and there is no nausea. Its action may be made still 
more beneficial by adding about sixty grains of bitartrate of 
potassium. Jalap is the cathartic to be used when the blood 
is charged with poisonous substances, as in Bright' s disease. 
It may also be given to remove the ascites and dropsy of this 
disease, especially when the dropsioal effusion begins to threaten 
the lungs; and to relieve the cerebral congestion which is some- 
times an accompaniment of certain forms of this disease. In 
those cases of congestive bronchitis where the patients have a 
short cough, great hyperemia in the chest without much secre- 
tion, shortness of breath, etc., and which may go on to danger- 
ous suffocative bronchitis, a prompt cathartic will often cut 
short the attack, and, as one is indicated which produces a 
watery flow, jalap should be given. Purgative dose of jalap is 
3i.-3i., combined, if desired, with a small dose of calomel. 
The compound powder of jalap (Pulvis jalapce compositus) 
is formed of jalap thirty-five parts, bitartrate of potassium 
sixty-five parts. 

Podophyllum 

Is the outer root of the Podophyllum peltatum, or may-apple 
of North America, growing in the Northern and Middle States, 



240 NOTES ON" MATERIA MEDICA. 

and is best when obtained just after frost has set in. In its ac- 
tion it is as irritating and acrid as colocynth, producing bloody 
vomiting and discharges > with inflammation of the intestines. 
It is the most certain cholagogue of all the vegetable cathartics, 
but its action is very slow, and, unless combined with other 
drug.-*, cannot be hurried. On account of its action upon the liver, 
it is of considerable use as a cathartic in cases where constipated 
patients have been malarious. It should be combined with a 
small dose of compound extract of colocynth. The dose of the 
resin, which is the only trustworthy preparation, varies from 
one-sixth to one-half of a grain. 

Elaterium. 

A substance deposited by the juice of the fruit of Momordica 
Elaterium, a small trailing vine growing on the shores of the 
Mediterranean Sea. It is very uncertain in its strength, and 
on this account has been omitted from the official list, and its 
active constituent, Elaterin, substituted. The latter consists of 
small, colorless shining scales or prisms, without odor, which are 
not altered on exposure to the air, and have a somewhat acrid 
and extremely bitter taste. 

When civen in full therapeutic doses, it produces a copious 
serous discharge, which may contain albumin and even blood, 
with great prostration of the nervous system which may be fatal. 
Elaterin operates by paralyzing the solar plexus, and, when given 
in toxic doses, its symptoms resemble those of cholera. It is the 
most efficient of this class of medicines in producing absorption 
of dropsical effusions in renal disease. It has been claimed that 
it has the power of causing the elimination of urea by vicarious 
action of the bowels. It should always be combined with other 
cathartics (dose, gr. -gVrV)- 

Camboge (Oambogia). 

A gum resin obtained from the root of the G-arcinia Hanbu- 
rii, an East Indian tree. As a cathartic it produces a copious 
watery flow, but, owing to the violence of its action, it is not to 
be used in chronic constipation except of the most obstinate 



MEDICINAL REMEDIES. 241 

kind, as it leaves the bowels in a state of torpor, due to the re- 
action of overstimulation and secretion. Dose is from two to 
five grains with soap, but it is seldom given alone. 

Senna. 

The leaflets of several species of Cassia growing in Central 
Asia, India, etc. It is usually administered in the form of an 
infusion which has a very bitter and nauseous taste. This infu- 
sion combined with epsom salts and an aromatic makes the 
noted "black draught." Senna operates very beneficially in 
cases of intestinal atony following malarial disease, and where 
constipation is accompanied with biliousness. It is now put up 
in many elegant forms, which must be used interchangeably. 
It is also combined with sulphate of magnesium in capsules. 

Compound Cathartic Pills (U. S.) 

These pills have long been noted for the relief of portal con- 
gestion, and should always precede the administration of quinine. 
Each pill contains the following ingredients: Calomel, gr. i.; 
Abstract Jalap, gr. i.; Ext. Colocynth. Comp., gr. 1-J; Cam- 
boge, gr. £. The full dose is three pills. 

Croton Oil (Oleum Tiglii). 

This is a fixed oil obtained from the seed of the Croton Tig- 
lium, a plant growing in the southern part of Asia. It is vio- 
lently irritating both to the skin and gastro-intestinal tract, 
producing to the greatest degree the catarrhal effects of oil. It 
mixes readily with any other oil, and one part croton oil to nine 
parts sweet almond oil is very effective as a counter-irritant in 
catarrhal bronchitis, congestive 'bronchitis, and in certain stages of 
phthisis, as, applied to the chest, it gives rise to a very extensive 
eruption. The strength will have to be increased as the skin 
becomes habituated to its use, until finally the pure oil itself may 
have to be applied, which then produces no greater effect than 
its original application of one part in ten. In the spinal irri- 
tation occurring most frequently in women and young. girls, 
16 



242 NOTES OX MATERIA MEDICA. 

partly nervous, but mainly dependent on weak muscular power- 
where there are several tender places along the spine, especially 
over the sacrum, counter-irritation works very well, and croton 
oil may be applied in the manner above described. 

Given internally, croton oil is an intense hydragogue cathartic, 
acting more powerfully than any other, and producing profuse 
discharges with griping pain. It should be used when a speedy 
and complete evacuation of the bowels and a diminution of the 
arterial pressure are demanded; and the smallness of the dose 
(gtt. i.-ij.), and the fact that it acts if simply placed on the 
tongue, indicate that it is to be used in those cases where con- 
sciousness or deglutition is suspended and a cathartic is needed. 
It is, therefore, to be given in coma, especially if it be apoplec- 
tic, but not if the patient is in a state of syncope; in other words, 
if the pulse is full and strong, give a cathartic to prevent fur- 
ther cerebral inflammation; if weak and irregular, do not give it. 

Croton oil is also to be recommended as a purgative in the 
early treatment of cerebrospinal meningitis when the symp- 
toms are high fever, stiffness of the muscles of the neck, etc. 
It should also be used to remove an impaction of fasces in the 
intestines when other remedies fail. 

(c) Saline Cathartics. l 

This class of purgatives have a peculiar mechanical action, 
which depends on their saline properties. They are extremely 
difficult of absorption, but remain in the intestines, and by their 
presence act on the mucous membrane, causing an increase of 
secretion. But this is only a part of their action. As the nat- 
ural secretions are poured out, this class of purgatives, through 
their affinity. for water, prevent their reabsorption, and thus in- 
crease the liquid part of the faeces. Their action is analogous 
to that of an enema. As they do not increase the secretion 
of the intestinal juices, they are not followed by constipation. 
These are true hydragogues, as they produce a flow of water. 
They act rapidly, producing little or no griping, and are not 
followed by prostration. They are very useful where the de- 

1 See also Mineral Waters, p. 101. 



MEDICISTAL REMEDIES. 243 

jecta are scanty in quantity and dry, as in the case of drunkards; 
also to remove accumulated faeces and irritating matters from 
the intestines, except when they have produced inflammation. 
Their prolonged use is to be avoided, for by preventing reab- 
sorption of the intestinal juices they impoverish the blood. On 
account of their refrigerant action, they should not be given in 
chlorosis, jaundice, Brighfs, or any exhausting or depressing 
disease. Their effect is increased by adding small doses of qui- 
nine. When given in small doses (one-eighth of a purgative 
dose), they act as diuretics. The saline cathartics are contra- 
indicated in fevers and when iron is administered, as they pre- 
vent its absorption. 

Sulphate of Magnesium (Epsom Salts). 

This is an intensely bitter, crystalline salt, causing free 
watery discharges. It seems to act especially on the mucous 
membrane of the duodenum. Its cathartic action is increased 
by dilution with water, and it appears to be more active when 
dissolved, in hot water. The addition of quinine also increases 
its power of acting upon the intestine, a grain of quinine to a 
drachm of sulphate of magnesium in a tumbler of water rarely 
failing to produce all the laxative effect required. Sulphate of 
magnesium causes less depression than any of the other saline 
cathartics, but if given too often it produces intestinal debility 
and a tendency to ancemia. Combined with senna and an aro- 
matic, it forms the well-known " black draught" (dose of Sul- 
phate of Magnesium: laxative, 3 i. ; purgative, fss.). 

Sulphate of Sodium (Glauber's Salts). 

In some respects, this salt is superior to the sulphate of mag- 
nesium, but, on account of its extreme bitterness, it is rarely 
taken, except in the mineral waters of Friedrichshall, Carlsbad, 
etc. (see Mineral Waters, p. 102). 

Cream Tartar (Potassii Bitartras). 

This salt has a pleasant, acid flavor, and is well borne by the 
stomach. G-iven in doses of half an ounce, it will act as a'hydra- 



244 KOTES ON MATERIA MEDIC A. 

gogue cathartic without any griping or other bad symptoms. 
In sixty-grain doses, it operates as a diuretic, and is to be given 
in fevers when the secretion of urine is deficient. Combined 
with lemonade, it makes a cooling drink, and its diuretic prop- 
erties may be increased, if desired ? by adding some other diu- 
retic. It is especially useful in the hot stage of chills and fever, 
in all eruptive fevers, and for children in scarlet fever. 

Tartrate of Potassium and Sodium (Eochelle Salts). 

This is the most palatable of any of the salts, and it acts with- 
out griping. When given just short of the purgative dose, it 
acts as a diuretic and increases the alkalinity of the blood. 

Phosphate of Sodium (Sodii Phosphas). 

This operates as a mild cathartic, and is very useful for chil- 
dren, since, tasting like common salt, it may be put in milk or 
gruel (dose, § ss.). Being an antacid, it is a good prophylactic 
for some of the attendant troubles of rheumatism — skin disease, 
bronchitis, slight rheumatic pains, etc. — and may also be given 
in cases of malnutrition that occur in rheumatic families with 
scrofulous tendency. In acute articular rheumatism, the blood 
should be made alkaline as soon as possible, and more powerful 
drugs than phosphate of sodium are required for this purpose. 
As this salt is a constituent of the blood, poisoning need not be 
feared. 

2. Emetics. 

Emetics are drugs given for the purpose of producing vomit- 
ing. They are unpopular medicines, cathartics generally tak- 
ing their place, but in certain conditions they do a great deal of 
good. Thus an emetic given at the very commencement of an 
attack of tonsillitis will very often abort the disease at once, as 
it causes a free flow of mucus from the pharynx, which acts as a 
local depletive. Emetics are of two kinds: (a) cardiac, (b) ir- 
ritant. 

(a) Cardiac Emetics. 

Cardiac emetics produce nausea and vomiting by their action 
upon the heart, reducing its action, and causing in this manner 



MEDICINAL REMEDIES. 245 

anaemia of the brain and great prostration to the system, simi- 
lar to that caused by extreme loss of blood with its accompany- 
ing deathlv sickness. It is upon this action only that their 
emetic properties depend. The medicines which act as cardiac 
emetics are neurotics. They produce intense nausea, and the 
vomiting is persistent and often uncontrollable. Those belong- 
ing to this class are digitalis, colchicum, tartar emetic, lobelia, 
tobacco, etc. They are not medicinal emetics, but the emesis 
is due to their poisonous effects. 

Apomorphine ' (Apomorphinse Hydrochloras). 

This is the hydrochlorate of an alkaloid obtained by heating 
morphine or codeine in sealed tubes with hydrochloric acid. It 
forms in small, grayish-white, shining needles, which are in- 
odorous, faintly acid, and turn green on exposure to light 
and air. It is much used in Europe to produce emesis, but it 
produces great depression of the system, and on this account is 
not to be recommended. It may be given in cases where, for 
any reason, ordinary emetics cannot be administered, as in cases 
of narcotism where the patient is unable to swallow (dose, gr. ^ 
by the mouth, gr. -|- ^ hypodermatically). Patients usually 
vomit three times before the action of the drug ceases. 

Irritant or medicinal emetic* owe their properties to their 
irritative effects, producing vomiting by reflex action. Thus 
emesis of this kind may be produced by tickling the back of the 
tongue with a feather or with the finger, or by drinking warm 
water containing a certain proportion of mustard or salt, the 
irritant properties of the mixture causing a decrease in the 
secretion of the digestive juices, and vomiting. The vomiting 
produced by irritant emetics is free from nausea, and there is 
no depression of the system. They also act more quickly than 
the cardiac emetics, and so are to be given in all cases where 
rapidly induced vomiting is desired. 



1 The other emetics of this class are treated of elsewhere, as, owing to the 
great depression following their administration, their use as emetics is not 
to be recommended. 



246 NOTES ON MATERIA MEDICA. 

Contra-indications to the use of emetics: (1) No person over 
the age of fifty years should ever take emetics, as the act of 
vomiting produces great cerebral congestion, and the act itself 
increases in difficulty after the fortieth year has been passed. 
(2) Where poison has been taken. ' Here the stomach pump or 
stomach siphon should be used to empty the stomach. (3) 
Emaciation. Owing to the stomach getting well up behind the 
ribs, many thin persons cannot vomit, or can do so only with 
great difficulty. This, to some extent, may be obviated by giv- 
ing the patients liquids to distend the stomach and bring it in 
contact with the abdominal walls. (4) Obesity. Here there is 
difficulty in vomiting on account of the muscular weakness of 
the abdominal walls. 

(b) Irritant Emetics. 

Ipecacuanha. 

Ipecacuanha is the root of a Brazilian shrub, Cephaelis Ipecac- 
uanha. It contains an active alkaloidal principle called emetine. 
Locally applied, ipecacuanha acts as a direct irritant, causing a 
peculiar eruption which lasts from five to six days. In this 
way it can be used as a counter-irritant — for example, in tuber- 
culosis of the lungs — to raise sores on the surface of the chest. 
Tartar emetic was formerly used for this purpose, but the sores 
produced by this substance left scars, while those produced by 
ipecacuanha do not. (Mix gr. x.-xv. ipecac, in r ss. of lard.) 
As a general emetic there is nothing to be compared with ipe- 
cacuanha, It is not a cardiac emetic, and therefore not pros- 
trating to the system. When taken into the stomach, it causes, 
by its irritant action, a considerable flow of mucus, and, in the 
vomiting which ensues, the contents not only of the stomach 
but also of the duodenum are expelled, and the liver, by the 
mechanical action of the abdominal muscles, is stimulated in 
its circulation. Emesis, therefore, clears up a jaundiced coun- 
tenance more quickly than anything else, the bile pouring out 
rapidly under the influence of the drug. In many cases, there- 
fore, of hepatic congestion, and notably at the beginning of 
fevers, emesis gives great relief by reducing the fever and irri- 



MEDICINAL REMEDIES. 247 

tation. Children under two years of age naturally possess weak 
expectorant power, and when suffering from diseases such as 
acute capillary bronchitis, pneumonia, croup, etc, are often in 
an extremely perilous condition from their inability to raise the 
matter to be expectorated higher than the larynx. To aid 
expectoration, emesis may here be induced several times during 
the day and night at intervals of four or five hours. Prostration 
need not be feared, as vomiting does not have the same effect 
upon children as upon adults, regurgitation occurring very 
easily in the former. The emetic should be given as soon as 
the respiration increases in frequency and the breathing becomes 
labored from accumulation of mucus in the trachea. Emesis 
should always be used for the reflex laryngeal spasm in cough- 
ing which occurs in croup, and for the spasmodic cough in false 
croup. 

In the dangerous dysenteries of tropical climates, ipecacuanha 
is much used on account of its specific topical action in the 
large intestine. A sinapism or blister is placed upon the epi- 
gastrium, and as soon as this has acted gr. xxx. of ipecacuanha 
should be given as a dose with gtt. xxv. laudanum, and the dose 
repeated every hour until gr. xc. have been taken. The first 
dose may induce vomiting, but not the second or third. The 
effect is to change the whole dysenteric process. For the 
milder dysenteries of this country, castor oil is to be preferred. 1 

Where there is a tendency to tonsillitis, a disease which often 
precedes an attack of acute articular rheumatism, on the first 
manifestation of sore throat give ipecacuanha, which, acting as 
a local depletive, often aborts the disease, and apply iodine or 
bromine to the tonsils once or twice a day, as in the following: 

5 Tincturse Iodi, 3 iv. 

Tincturae Aconiti, ttj, xx. 

M. S. For local application. 

This should be diluted on the second day with tinctura cin- 
chonas comp. 



See also p. 234. 



248 NOTES ON" MATERIA MEDICA. 

Sulphate of Zinc. 

This is an irritant emetic, has good topical operation, pro- 
duces no prostration, and hence may be used as an adjuvant to 
ipecacuanha, the combination acting better than either emetic 
by itself (dose, Ipecac, gr. xx.; Sulph. of Zinc, gr. xv., for 
adults; for children proportionately less). To produce emesis, 
sulphate of zinc should not be given in small doses. Many pa- 
tients, dreading the nausea of an emetic, take small doses, think- 
ing that the smaller the dose the less there will be of sickness 
and nausea; but just the opposite actually occurs. A dose of 
gr. xx., therefore, is better than a dose of gr. xv., and still bet- 
ter than one of gr. x., which produces nausea but no vomiting 
(dose to child, gr. v.). This emetic operates in about ten min- 
utes. It should not be given unless it is certain that the patient 
will vomit. 

Sulphate of Copper. 

This drug, like all strong astringents, is also an emetic, pro- 
ducing emesis without any prostration of the system. It is 
much used by German physicians in the treatment of croup. 
It may be used in the early stages of this disease when there is 
considerable bronchitis, and before the period of excitement is 
followed by carbonic-acid poisoning. But when the latter stage 
has been reached, no emetics of any kind should be given, as 
the susceptibility of the stomach to these remedies is blunted 
by the carbonic-acid poisoning. As emetics soon become tole- 
rated by the system, it is well to use them interchangeably. 
Commence with ipecacuanha, and, after three doses have been 
given, change -to cupric or zinc sulphate. Sulphate of copper is 
far more irritating than the other emetics, and should not be 
repeated more than twice (dose as emetic: children, gr. i.-ij.; 
adults, gr. iij.-v.). 

3. Diuretics. 

Diuretics are remedies which have the property of increasing 
the volume of urine excreted from the kidneys, either by 



MEDICINAL REMEDIES. 249 

increasing the general blood pressure, or by causing local dilata- 
tion of the renal arterioles, or by direct irritation of the renal 
structure. When given for the relief of symptoms not depen- 
dent on any renal disease, diuretics are said to act generally ; 
when given for the relief of symptoms dependent on some de- 
rangement of the kidneys or genito-urinary tract, they are said 
to act locally. The following conditions of the urine are to be 
taken as indications for the administration of diuretics: (1) 
Urine of high specific gravity but of normal quantity. Saline 
diuretics are to be given, and, as this condition is indicative of 
high living and gouty diathesis, the diet is to be regulated and 
the use of alcohol and other stimulants prohibited. (2) Urine 
of high specific gravity tut deficient in quantity. This, if not 
due to excessive perspiration, indicates the use of saline diu- 
retics. (3) Urine with gravel or uric-acid deposits. This indi- 
cates a tendency to the formation of calculi, and therefore the 
prophylactic treatment is much more important than the cura- 
tive. Grive plenty of pure water, or water which contains an 
excess of carbonic acid. Liquor potassae may also be used in 
doses of half a drachm. If it is desired to render the urine 
alkaline, use the carbonate or citrate of potassium. The bitar- 
trate and the acetate are the most active stimulants to the kid- 
neys of the salts of potassium. (4) The presence of bile in the 
urine. When this occurs, the kidneys become irritated, and 
there is a tendency to/the formation of uric-acid deposits. The 
treatment should be to promote vicarious action of the skin and 
bowels, and to administer cholagogues. (5) Deficiency of urine, 
both in solids and quantity, due to renal congestion. This may 
be artificially produced by varnishing the skin, thus interfering 
with its excretory functions. A very similar condition to this 
exists in the desquamative stage of scarlet fever, it being imma- 
terial whether the desquamation be in large flakes or small 
scales. Therefore in this disease, as also in scarlatinal and acute 
nephritis, the object should be to re-establish the normal secre- 
tion of urine, and so diuretics should be given. (6) Deficiency 
in the quantity of urine in dropsical affections. This is due to 
the action of the kidneys being interfered with by the accumu- 
lation of fluid in the abdomen. The endeavor must be made to 



250 NOTES ON" MATERIA MEDIC A. 

remove this mechanical obstruction before the diuretics are 
given, otherwise it will be very difficult for them to act. 

Digitalis. 

The leaves of the Digitalis purpurea, or purple foxglove, a plant 
growing wild in Europe. As a diuretic, digitalis acts by increas- 
ing the propulsive power of the heart and raising the general 
arterial pressure. It produces a free flow of pale urine of low 
specific gravity, and its action, when once started, often con- 
tinues for four or five days, resulting in considerable prostration 
of the system. Its diuretic power is not decreased when used as 
a diaphoretic. Where there are idiosyncrasies its action may be 
uncertain, and if the arteries are diseased there is always dan- 
ger from the rupture of a blood-vessel, owing to the increased 
arterial tension. It is especially indicated in cases of acute 
nephritis, as the stimulant diuretics— i.e., those which act by 
causing a determination of the blood to the kidneys — are not to 
be given, as they intensify the renal congestion produced by the 
disease. 

Mercury. 

This substance, in combination with some other diuretic to 
direct its action to the kidneys, is the most reliable remedy in 
chronic Bright' 's disease, as it liquefies and causes to be absorbed 
the hyaline material which surrounds the arteries, hardening 
and constricting them, and setting up a slow process of inflam- 
mation which destroys the glandular structure. In chronic 
renal disease, the specific gravity of the urine is the index of its 
course. At first the specific gravity falls to 1.010 or thereabout, 
and remains stationary for a long time, and falls again at the 
close of the disease. When it reaches 1.006, danger is immi- 
nent. Calomel increases the watery flow of the urine, but not 
the solids. One grain each of calomel, squill, and digitalis is 
a good combination, and when the pulse becomes intermittent 
leave out the digitalis. One-twenty-fourth of a grain of corro- 
sive sublimate and a grain each of quinine, squill, and digitalis 
is also a good formula. When the use of mercury is to be con- 



MEDICINAL REMEDIES. 251 

tinued for a long time, the preparations with corrosive subli- 
mate are to be preferred. The above formulae can be used in 
dropsy, and especially in cardiac dropsy. 1 

Squill (Scilla). 

This drug is obtained from the bulb of Urginea Scilla. It is 
very irritant to the mucous membrane of the stomach and in- 
testines. When given in one to three-grain doses, it stimulates 
the pulse and causes determination of the blood to the kidneys; 
afterwards it depresses the heart and becomes an expectorant. 
It should always be combined with other diuretics. 

Turpentine (Terebinthina). 

The turpentine class of diuretics are active stimulants of the 
kidneys, producing arterial hyperemia even in a healthy person, 
and, if their use is continued, congestion; and the urine, which 
at first is albuminous and then bloody, becomes deficient in 
quantity; and, finally, there may be strangury with irritability 
of the whole genito-urinary tract. For the three sets of nerves 
in this region — viz., those to the kidneys, to the neck of the 
bladder, and to the glans penis — are intimately associated, so that 
irritation of the neck of the bladder 2 will cause irritation of 
the kidneys and sensation of pain in the glans penis. There- 
fore, when these diuretics produce renal congestion, there will 
be a painful sensation, referred to the anus or penis, causing 
a constant desire to micturate, and producing strangury because 
there is no water to pass. This irritation of the urinary tract 
is a serious matter; death sometimes resulting, in persons over six- 
ty, from the passage of a sound, which causes a sensation of chil- 
liness and suppression of urine very difficult to treat This sup- 
pression is difficult to account for, unless it is an illustration of 
the extreme sensitiveness and intimate relation of that part of 
the body to general vitality. In giving this class of diuretics, 

1 See also page 108. 

2 An injection of gtt. xiv.-xv. of fl. ext. of conium is to be given in all 
cases of pain in the neck of the bladder, and this treatment may also prevent 
the dangers following the use of the sound. 



252 NOTES ON MATERIA MEDICA. 

therefore, constant watch should be kept for these symptoms, 
many people having an idiosyncrasy against their use, so that 
great care has to be taken in their administration. 

These diuretics are useful in the treatment of chronic inflam- 
mation of the urinary passages, such as chronic pyelitis. This 
disease may be diagnosed in the following manner : Have the 
patient pass his urine in three different glasses. If the glass 
which contains that which was passed first contains the most 
pus, then the disease is urethritis; if pus is most abundant in 
the second or in all three equally, pyelitis ; and if in the third, 
cystitis. Hematuria may be determined in the same manner. 
Turpentine is valuable in the treatment of diseases of the 
uterus, as in painful dysmenorrhea which is spasmodic in 
character and shown by pain coming on before the flow. 
Chronic bronchitis, with offensive bieath, is benefited by its use 
in doses of five to ten drops. In the latter stages of typhoid 
fever, turpentine, which is also a valuable disinfectant in twenty- 
four-drop doses, is very good; but as soon as the desire to mictu- 
rate becomes frequent, discontinue its use. 

Buchu. 

Buchu leaves are the leaves of several species of Barosma, 
a shrub growing in South Africa ; the infusion has a strong 
aromatic odor, due to a volatile oil which readily yields to alco- 
hol and water. It is very safe, never producing strangury, but 
it may cause disturbance of the stomach. Buchu is very valu- 
able in the treatment of cystitis, especially when the stomach is 
irritable and weak, as it is borne much better than turpentine. 
If it is necessary to reduce the acidity of the urine, liquor potassae 
may be added : 

I£ Tincturse Belladonnas, 3 i. 

Extracti Buchu fluidi, . . . . § i. 

Liquoris Potassse, . .. « . . 3 vi. 

Syrupi simplicis, § ss. 

Aquae, ad f vi. 

M. Sig. Teaspoonful every three hours. (For chronic cys- 
titis.) 



MEDICINAL REMEDIES. 253 

It is also used in the spasm of the urethra, being an antispas- 
modic of the genito-urinary tract, and the infusion or the fluid 
extract may be used in bronchitis and phthisis with purulent 
exudation and spasmodic cough. 

Buchu is used to assist in the differential diagnosis of kidney 
disease. If it is given to a person with a small, contracted kid- 
ney, its odor will not be noticed in the urine, otherwise it will. 
Buchu and paregoric should be given in all cases of injury to 
the spine, to prevent pyelitis and cystitis. 

Juniper. 

Juniper is the fruit of the Juniperus communis. It contains 
an officinal volatile oil which forms the basis of the preparations 
representing the drug and upon which depend their medici- 
nal properties. In cases of irritable stricture of the urethra, 
in atony of the bladder (a condition which interferes very 
decidedly with the action of the kidneys), and in dysmenorrhea 
when there is a constant desire to micturate, juniper combined 
with gin is an effective diuretic. It is also very useful as a 
diuretic in dropsy not dependent on acute renal disease, e.g., 
cardiac or hepatic dropsy. In large doses, juniper causes 
strangury and renal inflammation, and its use should not be 
continued if the first dose is unsuccessful. It is, however, 
better borne by the stomach than either buchu or turpentine 
(dose, gtt. x. in tablespoonful of gin). 

Saline Dittketics. 1 

These, in addition to their action as diuretics, are also useful 
by being powerful oxidizers, and are to be used in febrile con- 
ditions. In pneumonia, it is well to add to the saline diuretics 
an ether, to direct their action both to the kidneys and to the 
sudoriparous glands. Of the saline diuretics, those of the pot- 
ash series are the best. Potassium acetate is the most diuretic 
(dose, 3 ss.). 

1 See also Mineral Waters, p. 101. 



254 NOTES ON MATERIA. MEDICA. 

The citrate of potash is the most palatable. It should he 
diluted very freely with water (dose, gr. xx.). 

As diuretics the nitrate and chlorate of potash should not be 
used when the kidneys are inflamed or irritated. 

4. Diaphoretics. 

Diaphoretics, or sudorifics, are medicines which increase the 
amount of perspiration. They are mainly used as eliminatives, 
but sometimes they are used for the purpose of reducing the 
temperature when this is above the normal. In fevers, for ex- 
ample, the skin is hot and dry, a condition which is invariably 
accompanied by thirst, and the sensory nerves are irritated by 
the bed clothes; there is consequently great restlessness, which 
aggravates the disease by preventing sleep and raising the tem- 
perature. If perspiration be induced, the thirst will be allayed 
and the temperature lowered. So also in diabetes, when the 
skin is dry, the patient's constant thirst will be lessened if the 
skin be kept moist. 

In using diaphoretics as eliminatives, it must be remembered 
that the skin is an eliminative organ only to a small extent, and 
only acts as such when the natural eliminative organs fail. 
Whenever, therefore, the skin is to be used for this purpose, it 
should always be prepared for this vicarious action, one of the first 
indications being to remove any existing tension of it; for when 
it has been dry for any length of time, the different epithelial 
layers are brought into close contact with each other, the orifices 
of the glands are closed, and thus the discharge of the secretions 
is prevented. This condition exists in fevers and generally in 
dropsy. In the latter disease, the dry skin is due to the subcuta- 
neous effusion acting as a mechanical obstacle to the capillary 
circulation, and thus arresting the secretions of the sebaceous 
glands by lessening their blood supply. An inunction of oil, 
therefore, is a valuable adjuvant to the diaphoretics when these 
conditions exist, as this opens the mouths of the glands and 
separates the epithelial layers of the skin. After the patient 
has been oiled, as another adjuvant he may be wrapped in a 
hot-water pack. 

Diaphoretics will not act when the other eliminative organs 



MEDICINAL REMEDIES. 255 

are in abnormal activity, and for this reason diaphoretics should 
not be attempted while the bowels are under the influence of a 
cathartic. 

Diaphoretics may be divided into two classes: (1) External ; 
(2) Internal. 

(a) External Diaphoretics. 

Dry Heat. 

This is seldom used, as it is only effective when the skin is 
moist, and this condition is generally wanting. 

Moist Heat. 

Hot steam is absorbed by the skin, and should never be used 
as a diaphoretic. Hot water is one of the surest ways to pro- 
duce sweating, but is very depressing. The best method is to 
use it in the form of a hot pack in the following manner: The 
body is first oiled, and the patient is then wrapped in a woollen 
blanket that has been moistened in boiling water and wrung as 
near dry as possible; over this a dry woollen blanket is wrapped, 
and around the whole a linen sheet. It should be assisted by 
warm diaphoretics internally. 

(p) Internal Diaphoretics. 

Internal diaphoretics are divided into two classes: (1) Depres- 
sant; (2) Stimulant. 

1. Depressant Diaphoretics. — These partially paralyze the 
heart and depress the arterial circulation, producing the cold 
sweat which is an invariable concomitant of a debilitated heart, as 
in fright, loss of blood, overdoses of colchicum, tartar emetic, 
aconite, etc. This class may be used when the skin is dry and 
hot, as in fevers. (For description of aconite, the principal 
member of this class, see p. 205.) 

2. Stimulant Diaphoretics. — These give the warm perspira- 
tion of exercise. With the exception of jaborandi, these 
diaphoretics will not act if the skin is cold, some other action 
being produced, e.g., Dover's powder becomes expectorant or 
diuretic, alcohol becomes diuretic, etc.; so that in administer- 



256 XOTES OX MATERIA MEDICA. 

ing this class it is necessary that the patient shall be kept 
warm. 

Dover's Powder (Pulvis Ipecacuanha et Opii). 

This is the most commonly used diaphoretic of this class. 
In the last Pharmacopoeia, sugar-of-milk has been substituted 
for sulphate of potassium. Singularly, it can be made to act 
better by combining it with aconite, as this allays the surface 
irritability of nervous hyperemia (Dover's Powder, gr. ij.-v. ; 
Tincture of Aconite Root, gtt. v.). 

Ammonia. 

The preparations of ammonia in free doses are all diapho- 
retics, some, however, being more effective than others. Liquor 
ammonii acetatis (or the spirits of Mindererus) was much used 
at one time, but liquor ammonii citratis is now generally sub- 
stituted for it (dose, 1 ss'.-i. every hour). The carbonate in 
gr. v. doses every hour is also very good. 

Sweet Spirit of Nitre (Spiritus ^Etheris Nitrosi). 

This drug with a little alcohol in a hot drink acts well as a 
diaphoretic. All hot drinks, and hot water itself, produce 
better diaphoresis if slowly sipped than if taken rapidly; the 
process of sipping relaxing the arteries and stimulating the 
heart. To abort a cold, and for the first stages of bronchitis 
when there is a good deal of dyspnoea, hot dry skin, etc., a hot 
drink of lemonade, infusion of flaxseed, and a teaspoonful of 
sweet spirit of nitre, sipped two or three hours before going 
to bed, is very effective. While taking this drink, instead of 
putting the feet in hot water (which will only increase the sus- 
ceptibility of the feet to cold, and probably cause a relapse on 
the following day), have the patient well wrapped up and let 
him sit in a warm place. The plan of giving a quantity of hot 
drinks during the night to induce perspiration is not to be 
recommended, as, although it works well for an hour or two, 
the patient is liable to catch another cold before morning. 



MEDICINAL REMEDIES. 257 

Jaborandi (Pilocarpus). 

The dried leaflets of Pilocarpus pennatifolius, a Brazilian 
tree. It contains several alkaloidal principles, the most impor- 
tant being pilocarpine, a colorless liquid, to which the chief 
effects of the drug are due. Jaborandi is unquestionably the 
most powerful diaphoretic known, and were it not for certain 
drawbacks it would be used very extensively. Its power is not 
increased by combination, and it is not necessary to endeavor to 
assist or increase its action by keeping the patient warm, etc., 
as jaborandi operates at all times, and it is only necessary to 
keep the patient from getting chilled. 

The first effect of jaborandi is to cause flushing of the neck, 
which spreads quickly to the forehead, causing a sensation of 
dizziness; these effects appear almost immediately after it is 
given. 

Sometimes it causes salivation, and if this is excessive and in- 
terferes with the diaphoresis, which usually lasts for about two 
hours, the use of the drug should be discontinued; if not, the 
salivation, if moderate, may be disregarded. 

Jaborandi is particularly indicated whenever the skin is de- 
sired to act vicariously in the elimination of poisons from the 
blood; but on account of the very decided circulatory depression 
which it causes, it is contra-indicated in all conditions of fatty 
or weak heart. It should be used, therefore, in the anasarca of 
acute nephritis, scarlatinal nephritis, and in the dropsy of 
Bright 's disease when the heart is strong, as in these conditions 
the drug works surprisingly well; but it should not be given 
when the heart is weak and begins to dilate, as, although sweat- 
ing is produced, the patient is prostrated, and the dropsy is 
increased owing to the added weakness of the heart. It should 
not be given in fevers, nor should it ever be used in cases of 
pregnancy with albuminous urine and dropsy, as, although it is 
desirable to eliminate the urea which is being retained in the 
system and which may cause puerperal convulsions, jaborandi, 
by increasing the weakness of an already debilitated heart, may 
cause death. (Pilocarpine, gr. i.-ij., and Eau de Cologne, § i., 
has been recommended to stimulate the growth of the hair.) 
17 



258 NOTES OX MATERIA MEDICA. 

Dose of fluid extract of jaborandi, the most trustworthy 
preparation, 3 ss.-i. Dose of pilocarpine, gr. -J-J hypoder- 
matically (this may be given twice a day in urgent cases of 
Bright' } s disease, especially in the young). 

5. Expectorants. 

Expectorants are drugs which promote the bronchial secre- 
tion, or modify its character so as to facilitate its expulsion, or 
which evacuate it with greater ease. Not infrequently the word 
is applied to any medicine used to relieve a cough. Expecto- 
rants may be divided into two classes: (1) Nauseant; (2) Stim- 
ulant. 

1. Nauseant expectorants are really emetics in doses too small 
to cause actual vomiting. They increase the flow of mucus 
from the membrane of the bronchial tubes. In its normal con- 
dition, the secretions of the mucous membrane are not mani- 
fest, only a very small amount necessary for the moistening of 
the membrane being exuded. Tartar emetic and squill are 
the most reliable nauseating expectorants, the latter being most 
effective in combination. 

2. Stimulant expectorants, so-called from their effect on the 
circulation, acting upon the veins of the mucous membrane. 
To this class belong the balsams and ethers, and, on account of 
the chloric ether it contains, perchloride of iron. 

(The indications for the use of both the nauseant and stim- 
ulant expectorants are given in the following article on 
Coughs.) 

Coughs. 1 A cough may be denned as a reflex act, whose single motor or 
efferent mechanism is called into play by a great variety of afferent impres- 
sions. Its one- proper object is expectoration, but, much oftener than any 
other reflex act of the body, it occurs without its object, and is consequently 
useless. Coughs may therefore be divided into two classes : (a) Expec- 

J This article is a condensation of Prof. Thomson's paper on "The Signifi- 
cance of Cough with Reference to Treatment," read before the New York 
County Medical Society, December, 1888, and given by him in his lectures as 
an introduction to the subject of ' ' Expectorants. " It is published in full in the 
New England Medical Monthly of March, 1889. 



MEDICINAL REMEDIES. 259 

torant; (b) Non-expectorant or Useless. The distinctive character of all use- 
less coughs is to be found in their sound, which is specifically different from 
the sound of any expectorant cough whatever. A non-expectorant cough, 
no matter if it be so constantly or rapidly repeated as to produce prolonged 
paroxysms, always consists of a series of acts distinctly independent of each 
other, and hence may be likened to the separate blows of a hammer. An 
expectorant cough, on the other hand, is never single. It may consist of only 
one act of real coughing, but, if so, it is immediately followed by a sound 
which indicates the clearing of the pharynx, which is the last step in expec- 
toration as far as the respiratory tract is concerned. Generally, however, it 
consists of a number of coughs in which the sound distinctly connects each 
act, both with the one which precedes and with that which follows it, so that, 
instead of resembling the strokes of a hammer, it is more like the passing 
of the links of a chain over a pulley, or in some cases like the sound of a 
saw. 

(a) Expectorant Coughs. — These coughs are due to the presence of some 
material (which may be either a foreign body or secretion of fluid) in an air 
tube, causing a continuous imperative coughing until the offending material 
is removed. In the respiratory tract, there are certain sensitive areas, most 
marked at the bifurcation of the trachea and at the first and second divisions 
of the bronchi, and whenever a secretion collects in the bronchial tubes, so 
soon as it arrives at these sensitive parts the expectorant cough immediately 
begins, and does not stop until that place has been cleared. There may then 
be a lull until the secretion reaches another of these sensitive tracts, when 
the coughing again begins, and this process continues until the matter is 
finally expectorated. This continuous character of an expectorant cough is 
well illustrated in cases of chronic bronchitis with very viscid expectoration. 
The particle of mucus may be only a small globular but sticky mass, and 
yet, once started on its way, the patient has to devote his whole efforts in a 
succession of quick, powerful coughs, which it is impossible for him to 
check until he gets rid at last of a seemingly insignificant quantity for such 
a great and tumultuous effort. 

The indications, therefore, for the treatment of expectorant coughs are 
simple, and there are only three : (1) to make the phlegm so liquid that it 
will flow easily ; (2) to make the coughing powerful enough to be effective ; 
(3) to check or diminish the amount of superabundant secretion. 

1 . Remedies to render secretion less viscid, and so more easy of expulsion. 
— The drugs ordinarily recommended for this purpose, such as mixtures of 
ipecacuanha, squill, senega, chloride of ammonium, chlorate of potash, bal- 
samic mixtures with opium, etc. , while successful in a certain numbwr of 
cases, are not at all satisfactory in others, especially where the coughs are 
more or less chronic. Now, all oils that are taken up in any quantity from 
the intestine will always produce a watery flow into the bronchial tract, 
especially if directed to that mucous surface by a local hyperemia; much of 
the benefit of a flaxseed infusion in acute bronchitis being due to the oil of 



260 NOTES OX MATERIA MEDICA. 

the seeds. Accordingly, linseed oil seems to be indicated for the treatment 
of expectorant forms of cough, and it has been found by actual experience 
a most efficient remedy for this purpose. An initial difficulty was to make 
a stable palatable emulsion of the linseed oil, but this has now been over- 
come. 

The formula for the emulsion is : 

3 Olei Lini § xv. 

Olei Gaultheriae, 

Olei Cinnamomi, aa 3 ij. 

Chondri (Irish moss), § ss. 

Aquae, ... .... § xxiv. 

Glycerini, . . 3 v. 

Syrupi simplicis. § x. 

Acidi Hydrocyanici dil., 3 iiss. 

Of this emulsion the usual prescription for acute bronchitis is ; 

]J Misturae Olei Lini, ... § vi. 

Chloral, . 3 iss. 

Morphinae Sulphatis, gr. iss. 

M. S. Tablespoonful an hour after meals, and, if the coughing is severe at 
night, a fourth dose at bedtime. 

In order to allay the element of nervous irritability caused by the inflam- 
matory condition of the bronchial mucous membrane, there should be added 
to each tablespoonful of the emulsion six to eight grains of chloral and from 
To" to i of a grain of morphine. This emulsion is to be relied on, not only in 
acute bronchitis, but also in the most chronic forms of the disease where the 
expectoration is viscid and adhesive. It is an invaluable prophylactic against 
emphysema, and it not improbably serves as a direct nutrient of the pulmo- 
nary tissue. It is also of decided value in the treatment of bronchitic asthma, 
as well as in the asthmas which have a history of sequence to pertussis or 
measles. 

Another frequent indication for its administration is in the treatment of 
phthisis in patients who cannot take cod-liver oil, particularly in those who 
have much bronchitis. Of course, it can hardly claim to possess the nutrient 
properties of cod-liver oil, but it is much more easily borne by the stomach, 
and as a substitute for it, where such has to be found, it is much superior to 
cream or other proposed substitutes. In many phthisical cases also that can 
take cod-liver oil, but in whom the cough is very racking, the emulsion may 
be temporarily administered to relieve the cough by changing the character 
of the expectoration. It is not to be used in cases of capillary bronchitis or 
broncho-pneumonia, nor in those cases of bronchitis occurring during epi- 
demic influenzas where profuse nasal catarrhs alternate with bronchitis, as 
here the coughs are of infectious origin and generally have to run their 
course. The same may be said of intercurrent bronchitis in fevers, as those 



MEDICIXAL REMEDIES. 261 

depend often on pure muscular weakness of the bronchial walls combined 
with cardiac failure from the fever ; also in secondary bronchitis of heart 
disease, as well as in toxic bronchitis from gout, Bright's disease, etc., and 
in all cases of bronchorrhcea, whether senile or from bronchial palsy in fibroid 
degeneration of the lungs. 

2. Remedies to make the act of coughing 'powerful enough to be effective.— A. 
condition in which expectorant power is often imperatively needed is the ca- 
pillary bronchitis or pneumonia of young children or infants. Here recourse 
may be had to the physiological association l which exists between the oesopha- 
gus and respiratory tract ; for it has been shown that each act of swallowing 
produces a distinct stimulant effect upon the heart as well as upon the me- 
chanism of expiration, and hence in the severe dyspnoea of children's pneu- 
monia the little patients should be kept for prolonged periods swallowing half- 
teaspoonf ul doses of hot milk and lime water, to aid their failing power of 
expectoration. On the same principle, the sipping of a cup of hot coffee for 
phthisical patients before they rise in the morning, to facilitate their fits of 
morning expectoration, is to be recommended. 

3. Remedies to check or diminish superabundant secretion. — The indication 
for these remedies occurs especially in the passive bronchorrhcea of old persons, 
in cardiac weakness, and in most cases of chronic bronchitis with emphysema. 
For many such cases of chronic bronchitis there is no better treatment than 
with the Tinct. Ferri Muriatis to tone the heart and weakened bronchial mus- 
cles. Along with this action may be found that of the adjuvants, Tr. Nucis 
Vomicae, Digitalis, Citrate of Caffeine, and Sweet Spirit of Nitre. In other 
cases, as in phthisis with profuse bronchial discharge, dilute nitric acid is 
indicated to check secretion, and occasionally a very good effect may be 
obtained in these cases from three-grain doses of zinc oxide. 

(b) Non-expectorant or Useless Coughs. — These coughs, of which there 
are no less than fourteen kinds more or less common, do not subserve any 
good purpose, and the aim, therefore, should be to arrest them. The nature 
of these coughs with their appropriate remedies will be dealt with in their 
order. 

1. Coughs due to simple inflammatory irritation without secretion of some 
portion, or the whole, of the respiratory tract from the epiglottis down to 
the third division of the bronchi. A typical instance of this is to be found 
in the purely hyperaemic stage of acute bronchitis, when, with a tumefied 
and dry state of the bronchial mucous membrane, we find the patient much 
oppressed for breathing and constantly tormented with a frequent short and 
hacking cough, each act of coughing evidently increasing his sense of sore 
ness and tightness of the chest. Auscultation reveals a number of dry, 
whistling rales, often more pronounced on expiration. 

To turn the cough into the expectorant variety as soon as possible, nauseant 
expectorants which start secretion should be given. For this purpose one 

1 For other examples of this physiological association, see pp. 277 et seq. 



262 XOTES OK MATERIA MEDICA. 

grain of tartar emetic should be dissolved in a teacupful of water, and the 
patient directed to take a teaspoonf ul every ten minutes until he begins to be 
nauseated, when usually the dyspnoea vanishes and the cough becomes loose. 
A much more common example of this cough, however, occurs in the 
course of ordinary bronchitis, both acute and chronic, where, owing to the 
fact of the co-existence of secretion and more or less free expectoration, its 
presence may be overlooked and it be confounded with the expectorant 
cough. In these cases, the patients have a number of distressing and pain- 
ful separate hacks without bringing up anything, their cough, however, 
every now and then terminating in the continuous expectorating kind. In 
all such cases, though there may be considerable secretion, yet it is unequally 
distributed in patches of viscid coating with inflamed spaces between, and 
particularly if the dry surfaces are about the bifurcation of the bronchi. 
These cases of mixed expectorant and non-expectorant coughs are especially 
frequent in the course of phthisis, as we then have ulcerated conditions in 
the track of decomposed pus expelled from vomicae or from pouches of di- 
lated bronchi. It is necessary, therefore, to listen to the patient's coughing 
in order to determine the ratio between the expectorant and the non-expec- 
torant sounds, and, if there be a considerable number of the latter, to add 
the sedative neurotics to the cough mixture. Of these, a small dose of 
chloral with a small dose of morphine (which is better than a full dose of 
either separately) is to be given, with the addition of aconite in febrile cases. 
Eight grains of chloral and one-eighth of a grain of morphine for an adult 
are quite sufficient. These neurotics are to be given for the non-expectorant 
element in the cough exclusively. So far as expectoration itself is con- 
cerned, they are drawbacks and not helps. In the passive bronchorrhcea of 
the aged, with dilated hearts, in chronic bronchitis with bronchiectasis and 
emphysema, in capillary bronchitis, in pneumonia, and, lastly, in all condi- 
tions in which there is abundant secretion, they are not only useless, but 
may be quite mischievous, and they have no place in a cough mixture, un- 
less the sound of the cough betrays much useless irritation as a complica- 
tion. 

2. Cough due to pure inflammatory irritation of tlie pharynx. — This is com- 
mon enough in ordinary colds, and not infrequently the precursor of laryngo- 
tracheitis by extension. It is, however, one of the most obstinate troubles 
of advanced phthisis, giving rise to a constant tickling sensation in the 
throat which has been wrongly ascribed to reflex irritation from ulcerated 
surfaces lower down. For this, and for the same distress in phthisis, apply 
a powder of one grain of morphine to five of starch, with a brush, low down 
in the throat, as this often enables patients to get a night's rest from the 
arrest of the prolonged paroxysm of coughs, which otherwise would rarely 
stop until vomiting changed temporarily the sensation of the throat. 

3. Coughs due to irritation of the pleura. — The importance of recognizing 
a pleuritic origin or element in a cough can scarcely be overrated. Many 
cases of permanent damage to the lungs, including the induction of phthisis 



MEDICINAL REMEDIES. 263 

itself, might often be prevented if the frequent origin of a chronic cough in 
a pleuritic adhesion were more commonly recognized. Post-mortem revela- 
tions show that of all serous inflammations, those which lead to pulmonary- 
adhesions are the most common, often where they had not been at all sus- 
pected. There is generally a prolonged tendency to short, hacking cough 
after the patient has recovered from an attack of severe pleurisy. (The only 
exceptions, and these are only apparent exceptions, are in cases of hydro- 
thorax with renal disease, for in them the effusion is often too watery to 
leave adhesions after absorption.) These patients are specially prone to 
have their cough return with changes of the weather, a common source of 
aggravation of all symptoms due to adhesions of serous membranes, as in 
pachymeningitis, for example; but because their cough returns, then they are 
apt to ascribe it to their catching a fresh cold. The treatment should be to 
strap the whole affected side for six months or more after every attack of 
general pleurisy (explaining to the patients the necessity of the procedure), 
to allow of as perfect rest as possible to this unresting respiratory surface, as 
otherwise the embers of the original inflammation will not go out and a 
permanent source of pulmonary mischief will remain. The immediate 
relief to the constant sense of uneasiness in the side, and the cessation of the 
useless, ominous, hacking cough which accompanies that uneasiness, very 
soon reconcile the patient to the trouble of wearing the straps. There are, 
however, many other conditions besides simple pleurisy where these con- 
siderations will apply. Whenever patients have the ordinary signs of phthi- 
sis, ask if they have been troubled with rheumatic pains about the shoul- 
ders. The answer will be frequently in the affirmative, the patient adding 
that he has often a pain behind the scapula, worse in stormy weather. 
These pains are sure to give rise to useless cough, the familiar, dry, hack- 
ing cough of early phthisis. As a means of diagnosis, laying the cold hand 
on the infraclavicular space over the affected part will immediately elicit 
several sharp hacks, when the same procedure tried first on the unaffected 
side will not do so. But a still more decided example of this kind of cough, 
and with much more injurious effects, is when a vomica has contracted 
extensive adhesions in front. The patients often then complain of an acute 
incisive pain through the lung, which constantly excites more coughing. 
Now, in both the early stages, and still more in vomical, this pleuritic 
cough cannot be otherwise than harmful and provocative of increased 
inflammation in the surrounding parts. When, therefore, the phthisical 
process is limited to one lung, invariably strap that side, and keep it so for 
months together. 

4. The spasmodic cough of pertussis. — This cough is specific in its kind, 
and not due to bronchitis. It may, therefore, be wholly suppressed in less 
than a week and not return, though the disease remains and runs its natural 
course, and may remain as infectious as ever without there being any cough 
present. If, however, the patient contract a cold before the six weeks are 
over, the whooping cough at once comes back and is then quite intractable 



264 XOTES ON MATERIA MEDICA. 

to the measures which at first arrested it, showing that the irritation of sim- 
ple bronchitis plays the same role in inciting the nervous irritability of 
pertussis that bronchitis does in exciting asthma. To arrest the cough or 
pertussis, bring the patient as rapidly as possible fully under the influence 
of belladonna. Nothing short of doses which will produce the physiologi- 
cal effects of the drug should be tried. In children, the dose should be 
enough to produce flushing of the skin, and repeated every two or three 
hours, night and day, for a week, after which the intervals of the doses 
may be gradually lengthened. Five grains of chloral may be added if, after 
the third day, the belladonna does not seem to have the full desired effect. 

5. The tracheo-laryngeal cough in children, occurring mostly at night and 
due to malarial infection. — It is quite paroxysmal and strongly suggestive of 
whooping cough. A sign upon which a good deal of reliance may be placed 
as a diagnostic of a malarial infection in children is the presence of blood- 
corpuscles in the urine under the microscope. Children with these malarial 
coughs often rise in the morning tired and fretful, with no appetite, with 
brownish-yellow coating of the tongue and considerable pharyngeal redness; 
but during the day they scarcely cough at all. If a small number of blood- 
corpuscles are found in the urine, a few doses of quinine are sufficient to 
arrest the cough. 

6. The nocturnal cough of children from some irritation in the alimentary 
canal, such as from indigestion, the presence of worms, etc. These should 
be treated by removing the cause. 

7. The uterine cough. — If it be meant by this term that the cough is 
associated with disorder of the female generative functions or organs, it is 
correct enough; but the starting point of the irritation may not be from the 
uterus, but rather from some of its accessories. This cough is often the 
loudest of all coughs, as in some hysterical women. Like other accompani- 
ments of hysteria, its treatment is most successful with purgatives like cas- 
cara, aloes, and rhubarb, with intestinal antiseptics like benzoate of soda, 
salol, and camphor, with the usual adjuvants of myrrh, asafoetida, and 
valerian, and the bromides. On the other hand, in women more advanced 
in life there may be a local cause in the cervix uteri, the removal of which 
may be all that is necessary The cough of chlorotics, which so often ex- 
cites alarm as likely to be from phthisis, is doubtless of the same general 
character. 

8. The aneurismal cough. — The diagnosis may be facilitated by listening 
carefully over the trachea to the persistent croupy sound of the breathing, 
no matter how quiet the respiration may be. This cough is best relieved by 
morphine, but it is surprising how often its most distressing paroxysms can 
be warded off by a couple of leeches to the notch of the sternum. 

9. The cough produced by enlarged bronchial glands pressing upon the 
pneumogastric nerve. — This may be one of the earliest signs of phthisis, 
but, if so, it wholly differs in its nature and associations from the early 
pleuritic cough. It is almost invariably accompanied by excessive sensitive- 



MEDICINAL REMEDIES. 265 

ness of the pharynx. Very often this goes along with hoarseness or even 
aphonia and intractable vomiting, although there may be no vomica or scarce- 
ly any pulmonary symptom present. At other times there is a good deal 
of palpitation of the heart. In these cases, the normal bronchial breathing 
between the scapulae is much intensified. The hoarseness and vomiting 
will both cease after a while, usually with softening of the implicated 
glands, but all the symptoms, including the cough, can meanwhile be 
greatly relieved by repeated dry cupping between the shoulders. Of course 
this kind of vomiting with hoarseness in phthisis is wholly different from 
the same symptoms later on. 

10. Another example of purely reflex coughs is mentioned in text-books 
on diseases of the ear. Foreign bodies in the external auditory canal are 
especially prone to occasion it, and if we cannot find the reason for parox- 
ysms of apparently causeless coughing, we had better look for plugs of 
hardened wax in the ear as a possible explanation. 

Finally, we have the coughs of mitral insufficiency and of cardiac dilata- 
tion. Also the cough from irritation of the phrenic nerve in perihepatitis, 
and even in abscess of the liver, as well as in some cases of splenitis, each 
of which is to be recognized by its sound as having nothing to do with ex- 
pectoration of matter from the lungs, each also requiring its own and not a 
routine treatment. There remains one cough, however, which is always of 
grave import; namely, the cerebral cough. In a few cases of epilepsy, it 
may indicate nothing but a functional irritation, but when associated with 
symptoms of cerebral mischief it points to organic changes or irritative 
lesions affecting the cough centre in the medulla oblongata. This is parti- 
cularly apt to be excited by affections of the under surface of the cerebel- 
lum, or by effusion, abscesses, or tumors pressing the cerebellum down 
upon the medulla. 

Division III. — Astringents. 

Astringents are medicines which constringe muscular and 
fibrous tissue and diminish secretions, and are also employed 
for arresting haemorrhage by coagulating the blood. They act 
chemically upon the tissues, and, unlike the other medicines, 
do not assist one another by combination. They are divisible 
into: (1) Mineral astringents; (1) Vegetable astringents. 

1. Mineral Astringents. 
Lead (Plumbum). 

Lead is the most valuable member of this numerous class. 
While all other astringents, mineral and vegetable, given in large 



266 xotes o^r materia medica. 

doses, are very irritant to the mucous membranes, especially to 
that of the stomach, the acetate of lead (the only form of lead 
used for internal administration) does not have this effect. 
Therefore, where vomiting and purging are going on simultane- 
ously, as in choleraic diseases, no medicines being retained owing 
to the irritability of the stomach — vomiting being the exact oppo- 
site of absorption, not only in the act of expulsion, but in ab- 
stracting watery flow from the blood — an astringent must be 
given, and the acetate of lead is the only one that can be used: 
for (1) it is markedly sedative; (2) it is antiphlogistic; (3) it is 
an astringent. It is the most powerful astringent for diarrhoea, 
but should only be used as a last resort in that form of diarrhoea 
dependent upon intestinal fermentation where a great deal of 
irritation has occurred (antiseptics, with a little opium if there 
is pain, should be the treatment in the early stages of this dis- 
order). The acetate must be combined with calomel as an 
antiseptic, and with opium to assist in allaying the pain and 
irritation. In cholera infantum, when time must not be lost, gr. 
•^ calomel, gr. i. acetate of lead, gr. i. tannin, should be given. 
For choleraic diarrhoea with vomiting in an adult, the follow- 
ing can be given: ~ 

~B, Phimbi Acetatis, gr. xij. 

Pulveris Camphorse, gr. xij. 

Pulveris Opii, gr. iij. 

Bismuthi Carbonatis, gr. xij. 

Extracti Gentianae, q. s. 

M. et ft. pil. No. xii. S. One pill to be given after every 
movement of the bowels. 

The following is useful for cholera infantum with vomiting : 

~$ Hydrargyri Subchloridi, gr. i. 

Plumbi Acetatis, gr. iv. 

Pulveris Camphorse, gr. iv. 

Saccharat. Albse, gr. xij. 

M. et ft. pulv. No. xii. S. One powder every hour with a 
little water, and, if an anodyne is necessary, give one-half drop 
of laudanum rather than powdered opium. If vomiting and 
purging continue, one powder should be given after each 
attack. 



MEDICINAL REMEDIES. 267 

Patients who are confined to their beds for a long time are 
much emaciated, or suffer from the formation of bed-sores and 
severe neuralgic pains due to pressure on nerves. These may 
be prevented by placing under them a sheepskin or bear robe, 
and covering with a sheet. The parts should be rubbed with: 
5 Tannate of Lead, 3 i. ; Simple Cerate, 3 1. 

Lead and opium washes are excellent applications for erysipe- 
latous inflammations of the shin. They can be made in strength 
of gr. iij.-v. of the acetate of lead to 3 1. of the solution of 
morphine (U S). The mixture should be well shaken before 
using, as lead is incompatible with morphine, and so forms a 
precipitate. If continued for any length of time, this wash is 
apt to produce lead poisoning, a result which is to be carefully 
avoided. 

Lead Poisoning . — The sources of lead poisoning are numerous; those en- 
gaged in occupations requiring the use of lead, as painters, etc., are most 
frequently affected, but it is also common in country districts from the 
water being conveyed from the well to the house in leaden pipes. Lead 
poisoning is very insidious in its approach, and, owing to the obscurity of 
its symptoms, the diagnosis is difficult till neuralgias and liver troubles 
furnish the clue The first symptom is what the patient calls rheumatic 
pains, because they are worse when the weather is about to change; but 
that the pains are not rheumatic is shown, firstly, by the fact that they are 
not localized, ie.. confined to anyone joint, but travel over the course of 
the great nerves; and, secondly, the patient presses with his hand upon the 
seat of pain, thus showing that it is neuralgic, not inflammatory. After 
this there is a slow loss of strength and general cachexia, lasting for months, 
the patient continuing to suffer from neuralgias, headaches, and finally, 
owing to disordered liver, there will be considerable jaundice. The pulse is 
now of high tension, and many symptoms are developed closely resembling 
those of gout. The next most important symptoms from rapid absorption' 
of lead, as in the case of painters, are localized pain in the rectus abdominis 
and lead colic, the latter symptom being distinguished from hepatic and renal 
colic by the pains coursing only from the umbilicus to the pubes, and not 
extending to the back. Whenever severe abdominal pains occur without 
any inflammation, and it is certain they are not those of hepatic or renal 
colic, suspect lead poisoning. If the pain be in the rectus abdominis, the 
f aradic current will enable us to apply a pathognomonic test ; for the same 
effect will be produced upon this muscle by lead poisoning as upon the 
extensors of the arm, viz., the faradic excitability is reduced while the 
neighboring muscles are unaffected. Along with the colic, the patient is 



268 NOTES ON MATERIA MEDICA. 

apt to be extremely constipated After a time the grasping power of the 
hands and fingers will be weakened, and there will be "' wrist drop " Both 
hands are usually affected, and this symmetrical weakness is one of the signs 
of the disease. Next the deltoid muscles are affected, with consequent in- 
ability to raise the arms to any extent, and, lastly, the interossei muscles 
will be paralyzed. Another symptom will be the deposit of sulphide of 
lead on the teeth, or mucous membrane of the mouth, in the form of a blue 
line but absence of this blue line does not prove that lead poisoning is not 
present, for the teeth, for instance, may be false or have been constantly 
cleansed 

Treatment of Lead Poisoning. — The peripheral neuritis causes degenera- 
tion of a fatty kind of the muscle-cells of the affected muscles, which become 
almost saponified. The iodide of potassium should be given, and the patient 
brought rapidly under its influence until symptoms of iodism appear (close, 
gr x.-xx , or as much as the patient can bear, t. i. d. for a week). For the 
first three or four days, while the lead is being dissolved and eliminated, the 
pain will be increased. 

The faradic current must early be applied to the muscles, as, if left for 
any length of time without treatment, they may never recover. The inter- 
ossei are the most difficult to restore, but, as with the rest, it can be done by 
the patient and persistent use of the faradic current to each muscle sepa- 
rately The irritability produced by the current causes an increased flow of 
"blood to the part, making it warmer, increasing it in bulk, and awakening 
susceptibility to motor influence, 

Liquor Ferri Subsulphatis, 

Or Monsel's solution, is the most astringent and the least irri- 
tating of any of the salts of iron. 

Liquor Ferri Pernitratis, 

In closes of six to ten drops, is often used in the diarrhoea of 
phthisis and in chronic dysentery. 

Nitrate of Silver 

Is a very active astringent; as a caustic, a very small amount 
(^J of what is applied acts, since it unites with the albumin 
of the tissues, forming the albuminate of silver. It is useful in 
checking bleeding from the alimentary canal. A good formula 
for chronic dysentery or chronic diarrhoea is: 



MEDICINAL REMEDIES. 269' 

3 Argenti Nitratis, 

Pulveris Opii, aa gr. v. 

Terebinthinae Resinae, 3 iij. 

Sodii Bicarbonatis, 3 ss. 

M. et fiant pilulae No. lx. Sig. Three pills t. i. d 

Sulphate of Copper 

Kesembles the nitrate of silver in its astringent and caustic 
properties. When given internally in large doses, it acts as 
an emetic, from its irritant action. It can be substituted for 
the nitrate of silver in the above formula. Locally, it is the 
best application for chronic conjunctivitis. It should be applied 
in substance quickly and lightly to the granulations. 

Alum. 

Alum is largely used as a styptic, in domestic practice, to 
check bleeding. A paste made of alum, capsicum, and honey 
is very good for relaxed uvula. 

2. Vegetable Astringents. 

Taunin— Tannic Acid. 

Vegetable astringents are very numerous, and many of them 
were much used formerly in the treatment of diarrhoea, etc., 
but now tannin, which is the active principle of all vegetable 
astringents, is generally preferred. The powerful astringent 
qualities of tannin depend chiefly upon its property of coagulat- 
ing albumin and gelatin. Taken into the system, it causes 
hardening and shrinking of the tissues, both nervous and mus- 
cular, and on this account is of great use as a medicine where 
there is vital relaxation showing itself, more particularly in 
weakness of the vascular system, which results, as in vaso-motor 
paralysis, in cold sweats, nervous sweats, exudations from 
mucous membranes, as in chronic nasal catarrh, lachrymal dis- 
charges, watery diarrhoea, etc. , conditions that call for astrin- 
gent as well as tonic treatment. Tannin, given alone, deals only 
with the symptoms, not with the disease itself; so that- tonics 



270 notes on materia medica. 

are necessary to remove the cause by strengthening the heart, 
etc. Cold may also be used for the local treatment of these 
mucous discharges. Tannin is a good appetizer (dose, gr. "TJ - 
iij. ). Given in combination with quinine, it promotes its action 
and disguises its taste (quinine, gr. iij\-iv.; tannic acid, gr. i., 
which must be shaken, if in solution, as a precipitate is formed). 
It also assists the action of the mineral acids and does not pro- 
duce much constipation (dose of tannin, gr. iij.-iv., repeated at 
least four times a day). The addition of water to tannin changes 
it from tannic acid to Gallic Acid, which has some slight 
differences chemically, and medicinally it is not so astringent as 
tannin. Both are excreted by the kidneys, giving the urine a 
dark, smoky color, and therefore may be used in suppurative 
inflammations of the kidneys, as in chronic pyelitis. They may 
also be given for chronic cystitis. Tannin may also be used as 
a local astringent to check hemorrhage, and in the form of a 
tampon is used by some obstetricians for this purpose, but in 
post-partum hcemorrhage tannin should not be used under any 
circumstances. When the sputum has been slightly tinged 
with blood for several days, tannin may be given in haemoptysis, 
but not if it is very free. 



PART III. 



NON-MEDICINAL REMEDIES. 



NON-MEDICINAL REMEDIES. 



Non-medicinal remedies are those which act without entering 
the circulation, as counter-irritants, blisters, caustics, electricity, 
heat, cold, baths, change of scene or of air, massage, etc. 

Therapeutic Measures. 

Cold. 

Physically, cold is the absence of heat. Therapeutically, it is 
a positive agent, and has five actions : 

1. Tonic. 

2. Styptic. 

3. Antiphlogistic. 

4. Anaesthetic. 

5. Antipyretic. 

In the first three, cold acts upon the vaso-motor (not upon the 
cerebrospinal) system as a pure irritant neurotic. In the last 
two, it acts partly on physical principles, partly as a neurotic. 

1. Cold as a Tonic. 

When cold acts as a tonic, it is an irritant. Every irritant 
produces a shock and causes an expenditure of the energy of the 
part irritated, which, therefore, becomes depressed; but this de- 
press' on differs from that produced by a simple sedative, in that 
it is followed — provided the shock is not so great as to cause ex- 
haustion — by a reaction to or beyond the condition in which the 
part was prior to the irritation. Thus, cold, as an irritant, 
affects the vaso-motor system and produces a shock which is 
18 



274 XOTES OX MATERIA MEDIC A. 

followed by a reaction. In other words, this system is exer- 
cised, and all moderate exercise tends to strengthen the organ 
called into action, and permanently to improve its nutrition. 
Cold, then, is a vascular tonic, and may be used generally or 
locally. When the circulation is feeble and there is loss of 
muscular power, the general use of cold will arouse the heart, 
restore arterial tone, and thereby improve the nutrition of the 
whole body. For this purpose either the dip-, shower-, or sponge- 
bath may be used, according to the strength of the patient, tak- 
ing care never to cause exhaustion by its too frequent or pro- 
tracted use. A thorough reaction, as indicated by a glow of 
the skin, should always follow the bath, and never a sensation 
of lassitude or fatigue. When the irritant effect produced by 
the cold water alone is not sufficient, salt or some mild rube- 
facient may be added. In all cases, reaction may be assisted by 
friction with a rough towel. 

Dip laths, sea lathing, etc. — The manner in which the gen- 
eral application of cold affects the system is shown by the sudden 
stoppage of the heart and short respiratory acts whenever the 
body is suddenly immersed in cold water. The arteries become 
suddenly contracted and the heart embarrassed, and it is to this 
cause, and not to cramp, that the deaths of good swimmers, when- 
ever they plunge into extremely cold water, are generally due. 
It is not safe for persons to go in bathing who cannot stand a 
cold bath without loss of breath, and in all cases it is well to 
accustom the vaso-motor nerves gradually to the severe exercise, 
as it may be termed, given to them by bathing. The extensive 
application of cold, if given as a remedy, must be of short dura- 
tion. Most of those who go sea bathing are injured rather than 
benefited by it, because it is indulged in too frequently before 
the system has become accustomed to it. If the patient is too 
feeble to bear even the sponge bath, simple exposure of the sur- 
face of the body to cold air will often prove beneficial. The 
night sweats of phthisical patients may often be greatly relieved 
by having the patient get up during the night and exposing the 
skin until it is chilled, and then applying friction and returning 
him to bed. This has the same effect as an application of cold 
water, but, of course, in a less degree. 



NON-MEDICIXAL REMEDIES. 275 

• 

Hip baths. — These have an excellent action upon the circula- 
tion of the pelvic viscera where it is congested, as in prolapsus 
recti, prolapsus uteri, chronic piles, congested condition of the 
vagina with leucorrhcea, etc. The cold should be strictly limited 
to the part affected, the nerves above and below being well pro- 
tected; and, as many of these patients are women with feeble 
powers of reaction, care must betaken that the application is not 
too prolonged. At first the water should be tepid, and the pa- 
tient should not remain in it for more than five minutes, which 
may afterwards be increased to eight and the water made colder. 

Shoioer baths, cold douche, etc. — In shower baths there is another 
element besides the irritation of the cold water, viz., the force of 
the falling water, which is extremely severe, though, being dif- 
fused, it is not felt so much. These should never be used by 
any one who has not strong powers of reaction, and should cer- 
tainly never be given to a patient, especially one with cardiac 
disease. The shower bath is not so injurious, however, if con- 
fined to one part of the body only, as the head. Here it may be 
used for any sudden congestive condition of the brain with un- 
consciousness or convulsions, or where there is much hyperemia 
about the head and scalp without any renal disease (it should 
never be used in Bright's disease), as in puerperal convulsions, 
alcoholismus, and in the convulsions of scarlet fever. In the latter 
disease, when it occurs in children and commences suddenly, 
with vomiting, high fever, and convulsions, pour water on the 
top of the head from the height of one foot, and keep on pour- 
ing until the child returns to consciousness; because, if the pa- 
tient is allowed to remain in convulsions, the disease may ter- 
minate fatally. So in meningitis, when the patient is delirious 
or has a tendency to convulsions, cold water may be poured 
gently on the nape of the neck and on the head. 

The cold douche may also be used for any circumscribed in- 
nervation or malnutrition dependent on local weakness of the 
circulation. For example, rheumatic joints are apt to remain 
stiff and swollen for months or years after the attack, because 
the local inflammation embarrassed a normally poor local circu- 
lation. Cold, which stimulates the absorption of the fibrous 
exudation of rheumatism clogging the joint, will often restore 



276 NOTES ON MATERIA MEDICA. 

its natural condition, even after a long period. Water should 
be poured on it from a height of about two feet until there is 
an aching pain, when friction must be used. Pouring on hot 
water for a moment, by increasing the contrast, will produce 
still more beneficial results. If the stiffness of the joint be due 
to gouty deposits, cold is not of much uso. 

The cold douche or its equivalent is also of great use in vaso- 
motor weakness dependent upon sunstroke or malaria. After 
sunstroke, the patient is never the same again either physically 
or mentally. An injury has been done to the cervical ganglia 
of the sympathetic, and nervous control of the blood supply of 
the face and scalp, and possibly of the brain, has accordingly 
been weakened. The patient suffers from dizziness, flushing of 
the face, insomnia, and finally there may be meningitis or epi- 
lepsy, or such depression of spirits as may lead to suicide. 
Much good may be done by preventing the progress of the dis- 
ease. Unfortunately, cold, ergot, and nitrate of silver are the 
only vaso-motor tonics we have. Therefore, as medicinal treat- 
ment: 

3 Argenti Nitratis, gr. ± 

Ext. Ergotae, gr. iij. 

M. et fiat pil. No. i. Sig. To be given an hour after each meal 
t. i. d. For one week in every month add corrosive sublimate, 
g r - it 

In addition, the cold douche should be applied to the nape of 
the neck every morning, keeping the back of the head dry, for, 
if not, it may cause coryza. In two or three months there will 
be marked improvement under this treatment. 

What sunstroke does to the vaso-motor centres in the nape of 
the neck, malaria does to the centres in the lumbar region, 
causing vaso-motor weakness in the hepatic and splenic circula- 
tion. Any severe malarial infection will be felt for years after- 
wards, congestion of the liver or spleen following from slight 
causes, with chills, diarrhoea, jaundice, etc., and epistaxis. (If 
epistaxisis from the right nostril, the liver is affected; if from the 
left nostril, the spleen.) Quinine does no good here, as this is 
not a periodical disease, but the result of the weakening of the 



KON- MEDICINAL REMEDIES. 277 

vaso-motor centres of the spleen and liver. Ergot, nitrate of 
silver, and corrosive sublimate should be used with cold douche 
to the spine, repeated at times to the abdomen, or over the liver 
or spleen, as the case requires. A cold douche to the nape of the 
neck is also useful in false croup, or the crowing respiration of 
children; in tinnitus aurium, when the throbbing is synchro- 
nous with the heart's beat, and the tympanic artery distended — 
in this condition, the simultaneous exhibition of hydrobromic 
acid is of value; in chronic nasal catarrh and in all cases of 
unilateral headache with corresponding dilatation of the arteries, 
-and suffusion of the eye on the affected side. 

2. Cold as a Styptic. 

Cold acts as a styptic by causing contraction of the arteries 
through its influence on the vaso-moto r nerves. It is preferable 
to astringent drugs and other haemostatics, as it obviates the 
application of irritating substances to the bleeding part. It is 
not always necessary to apply it directly to the seat of the 
haemorrhage, for it will also affect distant parts in accordance 
■with certain laws of the vaso-motor system, of which the fol- 
lowing are the most important. 

The first laic is that organs which exist in symmetrical pairs, 
such as the hands, the feet, the eyes, and the ears, are so closely 
associated in their vaso-motor relations that the same effect, so 
far as their circulation is concerned, is produced in both by an 
impression made only on one member of the pair. Thus a 
thermometer held in one hand will drop 14° F. if the other 
hand be dipped in ice-water, while a thermometer in the axilla 
at the same time will mark no difference. In like manner, if 
the tip of one of the translucent ears of a rabbit be sharply 
pinched, the pulsating arteries in the other ear will at once 
contract into invisibility. It is on this principle that injury to 
one eye is so dangerous to the integrity of its fellow by consecu- 
tive inflammation. 

It is tortunate that organs that are not in symmetrical pairs, 
as the lungs and the kidneys, do not show anything like such a 
close nervo-vascular association. 



278 NOTES ON MATERIA MEDICA. 

The second law is that there is a close association between the 
sensory nerves of any part of the skin with the vaso-motor nerves 
of the organs or viscera which are immediately within that part, 
so that like impressions on the cutaneous nerves produce like 
effects on the circulation of the inner structures. Thus, if a 
cold hand be suddenly laid upon the praecordium, the heart will 
give a bound and for a moment stop ; so a cold hand laid on the 
abdomen will cause the uterus to contract ; a dash of ether 
spray on the chest is the quickest way to arrest an hcemoptysis, 
and a cold hand may often be used for the diagnosis of incipient 
phthisis. It may be tried by dipping the patient's own hand in 
cold water, so that he will not be so afraid of the procedure, and 
then laying it alternately over the right and left apex ; if done 
suddenly, he gives a short cough when the impression of cold is 
made on the affected side, but not when the application is made 
on the other. This principle is also illustrated in the recourse 
to all surface applications in internal disorders, such as rube- 
facients, blisters, and faradism to stimulate absorption, or poul- 
tices, etc., to allay irritation. No physician, in fact, should 
neglect cutaneous protection in all acute internal inflammations, 
such as pericarditis, pleuritis, etc., and in every case of phthisis 
or chronic bronchitis. 

The third law is that there are certain special vaso-motor asso- 
ciations of widely separated parts which have no obvious func- 
tional connection with each other. The first of these which we 
would mention is between the vaso-motor nerves of the pelvic 
viscera and those of the feet. Thus, females can stop menstrua- 
tion by putting their feet in cold water, while, on the other hand, 
there is no emmenagogue which at all equals persistent applica- 
tion of dry heat to the feet; so also we find in males with an 
irritable stricture of the urethra or an enlarged prostate, that 
nothing aggravates their infirmity so much as getting the feet 
wet or cold. On the same principle, if surgeons are troubled 
with bleeding in cutting for stone in an old case of vesical irri- 
tation, putting the feet in cold water will suspend the haemor- 
rhage. Again, irritation in the pelvis contracts the femoral 
artery; so that coldness and anaemia of the feet is the rule in all 



NO ^-MEDICINAL REMEDIES. 279 

instances of ovarian irritation in women, and in cystitis or pro- 
lapse of the rectum, etc., in men. 

Another such association is between the feet and the circula- 
tion of the pharynx and larynx. Putting the feet in cold water 
is followed by an immediate paleness of the pharyngeal mucous 
membrane, in contrast with the rest of the mucous membrane 
of the mouth. This association is quite unmistakable and pecu- 
liar, and best shown in normal cases. 

Still another such association is between the nape of the neck 
and the circulation of the nasal cavity. While the relations of 
the cervical sympathetic are known to be very wide in the con- 
trol of the circulation of the face, head, and throat, yet the 
close dependenca of congestions of the nasal cavity on abnormal 
innervation of the cervical nerves has not been as fully recog- 
nized as it should in the management of some of the obstinate 
maladies of a region in which vascular disorders are so apt to be 
tedious, because there is so little muscular tissue to aid in restor- 
ing tone to the affected structures. 

As a summary, the following instances will suffice to illustrate 
the application of these laws in the use of cold as a styptic: (1) 
cold water applied directly to a bleeding surface; (2) ice bags 
to the epigastrium to check hcematemesis ; (3) cold applied to 
one hand to check haemorrhage in the other; (4) cold foot baths 
to arrest metrorrhagia; (5) in post-partum hcemorrliage, where 
the best way of applying cold is by the ether spray, for the 
sudden and intense impression produced causes contraction of 
the uterus without chilling the patient. If the ether spray is 
not available, cold water should be poured from the height of 
two or three feet. The shock of the falling water assists the 
action of cold. These same measures may be used to control 
haemoptysis. 

3. Cold as an Antiphlogistic. 

As an antiphlogistic, cold may be used to arrest an acute 
inflammation, unless suppuration has occurred, or to prevent 
inflammation when threatened. This it does by causing a pro- 
tracted constriction of the arteries, thereby preventing the active 
congestion essential to all acute inflammation. The inflamma- 



280 KOTES OK MATERIA MEDICA. 

tion must be local, both as to cause and manifestation, and not 
be dependent upon a constitutional cause with a local manifes- 
tation. It should be invariably applied as dry cold, directly to 
the part affected, in sufficient intensity to relieve pain, but not 
so as to produce shock and reaction, and should be continued so 
long as the exciting cause exists. If, before the tendency to 
inflammation has entirely disappeared, a neuralgic pain occurs, 
it is a sign that the vaso-motor nerves have become exhausted, 
and the use of cold must at once be discontinued, or gangrene 
will result; moreover, the patient will feel more comfortable 
without than with the cold applications. This neuralgic pain 
is continuous, and, if the injured part be one of the extremities, 
it extends from the part injured toward the trunk. Inflamma- 
tory pain, on the other hand, is local throbbing, accompanied 
by local heat, and is relieved by more thorough applications of 
cold. In fractures, or other severe injuries near joints, the in- 
jured parts should be completely surrounded with pounded ice 
placed in water-tight receptacles, such as pigs' bladders, rubber 
bags, etc., two or three layers of perfectly dry muslin being 
placed between the skin and bags, lest the parts be chilled too 
suddenly. A bottle filled with ice-water makes a good anti- 
phlogistic splint for injuries of the hand. Inflammation of the 
eyes due to some external injury may be controlled, and its 
spread from one eye to the other prevented, by means of cold 
applications. If the inflammation is due to some internal injury 
of the eye, such as of the retina, cold will not control it. Ice 
bags should be applied to the head and spine in epidemic cerebro- 
spinal meningitis, and kept there during the # whole period of 
the inflammation. Cold applications will control the spread of 
erysipelas, and are the best means for relieving febrile headache. 
Headache from uterine trouble is best relieved by moist warmth. 
Cold should not be used antiphlogistically in any acute inflam- 
mation of internal organs, except peritonitis with vomiting, and 
meningitis. 

4. Cold as an Ancesthetic. 

The use of cold as an anaesthetic depends upon its physical 
property of freezing tissue and deadening sensation without 



NOX-MKDICIXAL REMEDIES. 281 

destroying vitality. It is most useful in operations where no 
great thickness of tissue is involved, as in opening abscesses, 
amputation of fingers, etc. In all cases, the effect of the cold 
should be secured as rapidly as possible. Apply ether spray to 
that part alone which is to be operated upon, the other parts 
being protected with some covering, such as chamois leather. 
Anaesthesia is complete as soon as the skin becomes white and 
glistening. Ehigolene may also be used for this purpose. 

5. Cold as an Antipyretic. 

It is only within recent years that we have been enabled to 
answer the exceedingly complex questions, what is the source of 
the heat when the bodily temperature is raised above the nor- 
mal, and how far will its direct abstraction be beneficial? A 
rise in the temperature of the body may be caused in three 
different ways, each of which has been considered as the genesis 
of fever: (1) increased oxidation in the system; (2) insufficient 
radiation; (3) derangement of the thermic centres and nerves. 
It may now be accepted as proven, that while the first two may 
give rise to the symptoms of fever, or be its accompaniments, 
they are not its direct cause, and it is to the third, therefore, that 
we must look for the explanation of the pyrexia. Experiments 
upon animals have demonstrated the existence of a heat centre ' 
in the corpus striatum which regulates the heat-producing 
function of the muscular system — a function which is entirely 
independent of muscular contraction, heat being evolved when 
the muscles are in a complete state of relaxation. Both heat 
genesis and heat lysis are under the control of the thermic 
centres and nerves, just as the circulation of the blood is under 
the control of the vaso-motor centres and nerves. Hence fever 
is due to a derangement of this thermic system, and neurotics 
such as aconite, and neurotic drugs of the carbolic-acid class 



1 There may be another centre in the spinal cord opposite the third cer- 
vical vertebra, as injury to the cord above this point will sometimes raise 
the temperature to 125° F , and injury below it will sometimes reduce the 
temperature below that of the dead body. The existence of this centre may 
be assumed to exist, though it has not yet been conclusively proven. , 



282 NOTES ON MATERIA MEDICA. 

such as antipyrine. are real antifebrile agents. Cold, therefore, 
which is an excellent neurotic, can be used as an antipyretic 
measure; for it not only directly abstracts heat, but also acts as a 
stimulant to the thermic centres, arousing them from the para- 
lysis or derangement of the fever. 

This derangement is due to a variety of causes, mainly toxic 
— the poison of septicaemia, for instance, producing the most 
violent fever known; and probably all fevers, with the exception 
of that in sunstroke (see infra, p. 283), are due to some form of 
poisoning. In every fever there is a certain point beyond which 
if the temperature rises certain structural changes will take 
place. The glands become affected with cloudy swelling, their 
secretions are arrested and fatty degeneration ensues, and the 
muscles become remarkably brittle. 

The point at which these changes occur differs in each fever. 
In scarlet fever, it is 105° F. ; in typhoid fever, 10G° F. ; in re- 
lapsing fever, from 107° to 108° F ; and in erysipelas still higher. 
Beyond this dangerous point in each fever the temperature should 
not be allowed to rise, but must be lowered by the use of cold. 
This may be effected by immersing the patient in a bath at 70° 
F., and gradually cooling the water down to 65° or 60° F. — 
never lower — at the same time using cold affusions to the head 
continuously. At first the temperature will rise slightly, owing 
to the blood being driven from the surface of the body into the 
viscera, which are always a little warmer than the skin; but the 
bath should be continued until the temperature is reduced to 
100° F., provided the fall is gradual — that is, one degree in six, 
five, four, or three minutes Never allow the temperature to 
fall below 100°, and if the immersion has to be prolonged for 
more than twenty minutes before the temperature breaks, do 
not wait until the temperature reaches 100°, but take the patient 
out when it is 101°. If it falls one degree in two and a half 
minutes, stop the bath whe-i the temperature has reached 101° 
F. ; for in most cases a further reduction of one degree will 
occur after the bath has been discontinued. If the fall in tem- 
perature during the bath be one degree in two minutes or less, 
the patient should be t iken out at once, whatever the actual 
temperature may be; for in such cases there is danger of the 



NON-MEDICIXAL REMEDIES. 283 

subsequent fall becoming uncontrollable, perhaps reaching 97° 
and causing the patient to pass into a state of colhipse. 
Should this at any time occur, wr.ip the patient in warm 
blankets, apply hot water to the epigastrium, and give brandy 
or other stimulants. When for any reason the bath is imprac- 
ticable, the cold pack 1 may be used, always observing, however, 
the same precautions as in the use of the bath. The cold pack 
or bath should be repeated often enough to keep the tempera- 
ture below the dangerous p >int of the disease. If necessary, use 
one every hour; but if only two or three a day are neede 1, one 
should be given when the highest diurnal rise in temperature 
may be expected, i.e., about two or three o'clock in the after- 
noon. 

Antipyretic Uses of Cold. 

In Acute Articular Rheumatism. — The application of cold is 
the only measure that will save life in the pyrexia of the severer 
forms of this disease. When this occurs, the patient becomes 
apathetic, ceases to complain of the pain in his joints, his face 
becomes dusky red in color, delirium sets in (an extremely bad 
sign in rheumatism), and this becomes intensified with every 
hour. Meanwhile the temperature has been steadily rising, and, 
if the disease terminates fatally, continues to do so even after 
death. When the temperature reaches 108°, the patient becomes 
comatose, and now death is inevitable unless cold is used, medi- 
cinal antipyretics being useless in this condition. Immerse the 
patient in cold water until the temperature of the body is 
reduced to 100°. When it is at 104°, the patient returns from 
coma to delirium, and when it is at 102° he is quite rational and 
will remain so for an hour or two, after which the temperature 
will begin to rise again, and the same process must be repeated. 
One- third of such cases will inevitably die, but with the remain- 
ing two-thirds the fever is broken by this treatment, the artic- 
ular rheumatism resumes its ordinary course, and the patient 
finally recovers. This disease shows that heat alone is sometimes 
the direct cause of death. 

In Sunstroke. — The same rapid elevation of temperature con- 



284 notes ox materia medica. 

tinuing after death, which occurs in the pyrexia of a r ;ute artic- 
ular rheumatism, occurs also in about two-thirds of nil the fatal 
cases of sunstroke. This condition is not due to any form of 
poisoning, as in the case of other fevers, but to the direct action 
of the sun upon the nape of the neck, deranging one of the 
thermic centres. Cold baths must be given in the manner al- 
ready described. It must be borne in mind, however, that there 
are two entirely distinct conditions of sunstroke: in the condi- 
tion for which cold is indicated, there will be coma, with elevated 
temperature, high tension of pulse, and the face will be suffused; 
in the other condition, for which stimulants and not cold are 
indicated, the face will be pale, the pulse weak and flickering, 
and the patient will be in a condition bordering on syncope. 

In Typhoid Fever. — The application of cold in combination 
with the administration of intestinal antiseptics takes the lead 
of all therapeutic measures in the treatment of typhoid fever, 
as, in the great prostration and muscular weakness of this dis- 
ease, cold directly abstracts heat from the affected muscles and 
keeps up their tone. AYhen the patient is delirious, with dry 
skin, rapid pulse, etc., immerse him in a bath at 75 p , and grad- 
ually make the water colder by the addition of ice, so that the 
initial shock shall not be too great, and the rise in temperature 
following immersion avoided. The temperature of the bath 
should not be lowered below 70°, or at most in severe cases 68°. 
After being taken out of the bath and placed in bed, the patient 
may shiver; if so, a slight dose of some stimulant may be given." 
His pulse is now stronger, the tongue is moist, he is able to take 
more nourishment, and perhaps perspires — a good symptom. 
If within two hours the temperature rises again, allow it to last 
for one hour, and then immerse the patient in the bath again; 
for the danger to be feared is heart failure from exhaustion, and 
experience proves that cold increases the muscular strength of 
the heart, tones up the nervous system, stimulates the secretory 
glands, and allows of perspiration. Medicinal antipyretics, as 
alcohol, ultimately only still further fatigue the heart, and the 
antipyretics of the carbolic-acid class, as antipyrine, antifebrin, 
and quinine, should not be given, as they are cardiac depressants. 

Other Uses. — The application of cold to the chest in pneu- 



NON-MEDICINAL REMEDIES. 285 

monia is not to be recommended, as it increases the congestion, 
and experience does not justify its use. Nor should it be used 
in peritonitis, except where the inflammation is localized. In 
those cases of perityphlitis caused by perforation of the appendix, 
where there is only local inflammation and no abscess threaten- 
ing general peritonitis, the ice bag may be used, and in many 
cases the inflammation will be reduced without the necessity of 
any surgical operation; though, if treatment by cold is not suc- 
cessful, recourse must be had to laparotomy. In some fevers, 
such as measles, for example, cold need not be used, and very 
rarely if ever in small-pox. In scarlet fever, which does not last 
for so long a period as typhoid fever, and where, consequently, 
the muscular exhaustion is not so great, a temperature of 104° t 
may be allowed for two or three days ; but if it lasts for a longer 
time or reaches 105°, cold should certainly be used. 

Heat. 

The actions of heat differ essentially, according as it is dry or 
moist ; the effect of one being directly opposed to that of the 
other. 

Dry Heat. 

Dry heat gives the simple action of heat. It is primarily a 
cardiac and vascular stimulant. It causes both stronger and 
more frequent contractions of the heart, and its use is of special 
value in all cases of failure or exhaustion of that organ. Car- 
diac failure is liable to occur in malignant, intermittent, and 
remittent fevers, cholera, the exanthemata, and notably in 
typhus fever, and sometimes in typhoid and in congestive mala- 
rial chills. The symptoms of cardiac exhaustion, with a ten- 
dency to stop in diastole, are: a terribly distressing sensation 
of sinking in the epigastrium; dyspnoea due to congestion of 
the lungs, producing shallow or gasping respirations; loss or 
alteration of the voice; insatiate thirst, due to congestion of the 
viscera; suppression of urine; pallor of the surface and coldness 
of extremities, with cramps in the flexor muscles, shrivelled 
skin, and anxious, drawn expression, with sharp, pinched fea- 
tures and sunken eyes. The surface of the body is generally 



286 NOTES ON MATERIA MEDIC A. 

covered with a cold, "clammy" sweat, and in exanthemata the 
eruption disappears, as no blood reaches the surface. In such 
cases, the heart must be aroused, both by the internal adminis- 
tration of brandy and ammonium, or by injection, and by the 
external use of dry heat. Wrap the patient in warm flannel 
blankets, then apply to the epigastric and pericardiac regions 
saucers heated by being dipped in boiling water, bottles of hot 
water, or bags filled with hot salt, ashes, etc. Dry heat should 
also be applied to the feet and calves of the legs, care being 
taken that these do not scorch the skin. 

If these means fail, then place the patient in a bath with a 
temperature of 102°-103° F. Mustard or capsicum may be used 
#to increase the stimulant action of the bath (ten grains of the 
powder to ten gallons of water) . Another remedy is the use of the 
f aradic current, one pole being placed at the nape of the neck, the 
other directly over the heart. The first indication of recovery 
is disappearance of the distress in the epigastrium, accompanied 
by a deep sigh and normal respiration; the voice returns to its 
natural sound; the cramps are relieved; the pallor, shrunken 
and " Hippocratic " expression of the countenance disappear, 
and if an eruption has previously existed it returns. 

As an Emmenagogue. — In most cases of amenorrhea, and 
especially in chlorosis, the patient suffers from cold feet, on ac- 
count of the relation which exists between the pedal circulation 
and that of the pelvic viscera, irritation of the ovarian plexus con- 
tracting the femoral artery and its branches. In these cases, it 
will be found that the long-continued use of the foot-stove during 
the day, and a hot soapstone at the feet in bed, will do more 
toward establishing the menstrual and other disordered func- 
tions than any other one line of treatment; for by this means 
the radiated ovarian irritations, which are at the bottom of all 
the trouble, are suspended, and the intestines are left free to 
perform their work. In order to encourage the patients to per- 
severe in keeping their feet warm, it is well to inform them that 
by so doing they will be relieved of the backache from which 
they all suffer. In sudden suppression of the menses, a hot 
pediluvium or other hot applications to the feet are among the 
best means of restoring the flow. 



NON-MEDICrSTAL REMEDIES. 287 

As a Diaphoretic. — To induce diaphoresis, strip the patient 
and roll him up in a hot blanket. The hot-air bath is given by 
placing the patient on a chair under which has been placed a 
lighted alcohol lamp; a blanket pinned closely around the neck 
and reaching to the floor confines the heated air. If the patient 
is too weak to sit up, the heated air may be introduced under 
the bedclothes, which have been elevated so as to form a kind of 
tent. 

The sudoriparous glands are stimulated both by the presence 
of heat and also by the large amount of blood which has been 
determined to the surface. Diaphoresis is assisted by thoroughly 
anointing the body with olive oil. 

As a Styptic. — Under certain conditions, hot water has the ef- 
fect of dry heat, and acts as a styptic. In order to obtain this 
effect, it is necessary that the water, through its high tempera- 
ture, should produce a shock to the nerves and so constringethe 
blood-vessels. Post-partum hemorrhage may sometimes be con- 
trolled by douching the spine with very hot water. A more 
certain way is by hot- water injections, 110°-112°F., thrown into 
the vagina, or into the uterus itself. 

Moist Heat. 

Moist heat is an anodyne and antispasmodic, being a pure 
sedative, the action not being that of the heat but of the water 
itself. If of low temperature, water is not felt by the nerves, 
the impression of .cold only being conveyed, because the con- 
traction of the unstriped muscular fibres has withdrawn the cu- 
taneous nerves, and the skin has accumulated over the papillae, 
producing the appearance known as goose flesh. If the water 
is of high temperature, there will be the stimulation of heat. 
Water, however, of the temperature of the body, 98.5°, gives us 
the full effect of moist heat, which is invariably depressing, as 
it abstracts nervous vitality; the hand, for instance, if immersed 
in warm water for half an hour, loses the sense of feeling and 
muscular power, and it is some time before this is fully re- 
covered from. So after immersion for the same length of time 
in a bath of this temperature, a person feels faint, the muscular 



288 stotes ox materia medica. 

system does not respond to motor impulses, and sensory impres- 
sions are deadened. Hence, for the purposes of stimulation, a 
hot bath should always be of short duration, two minutes at the 
outside; for, as soon as the temperature of the water is lowered, 
the patient will be subject to the depressing effect of moist heat. 

In the form of poultices, moist heat may be used in acute in- 
flammation to relieve the pain and to reduce the irritability. 
The drawback to its use for this purpose is that the vitality of 
the part is lowered; parts which had hitherto resisted the sup- 
purative process now yield, and it is necessary to use caustics to 
restore the weakened reparative power. In all inflammations of 
the internal organs, such as pleurisy, pericarditis, pneumonia, 
peritonitis, etc., the application of a large, warm poultice or 
fomentation over the whole region of the affected organs, by tak- 
ing advantage of the laws of vaso-motor nervous association 
(supra, p. 277), will often give decided relief. The soothing ef- 
fect will be increased by adding neurotics to the application. 

In acute articular rheumatism, the profuse perspiration may 
do harm by drenching the linen, thus chilling the patient and 
weakening the heart's action. The patient should be stripped 
and wrapped in flannel blankets, which absorb the perspiration 
and are poor conductors of heat. During the entire course of 
the disease, a warm poultice or a pad of cotton batting, covered 
with oil-silk, should be kept over the precordial space. 

The antispasmodic action of the warm bath is well illustrated 
by its power to relax the tissues around a strangulated hernia, 
and by its efficacy in renal and biliary colic, urethral spasms, and 
in the convulsions of children. As soon as the breathing of a 
child becomes rap:d, and there is paleness about the mouth, 
place it in a bath at once, for by this means the convulsion may 
be prevented, or, if it has already occurred, its duration will be 
shortened and the liability to repetition diminished. 

In all forms of laryngitis, croup, diphtheria, etc., the inhala- 
tion of steam is very useful; for in all of these diseases there is 
danger of asphyxia, resulting from spasm of the glottis, and para- 
lysis of the vocal cords due to the irritation. 

Mix four parts of water with one of molasses, and introduce 
steam through a tube into a tent which envelops the head and 



NON-MEDICl^AL KEMEDIES. 289 

shoulders of the patient, keeping the temperature of the air 
moderately high. The tent may be made of newspapers pinned 
together, a sheet, or anything which confines the vapor. It 
must not be made too small, or the patient will imagine that it 
interferes with his breathing. Care must be taken not to boil 
too long, as the vapor of molasses then becomes irritating. 
19 



GENERAL INDEX. 



Acid, boracic, 35 

carbolic, 24 

gailic, 270 

hydrochloric, 91 

hydrocyanic, 212 

nitric, 92 

nitro-muriatic, 93 

phosphoric, 94 

prussic, 212 

salicylic, 26 

sulphuric, 92 

tannic, 269 
Aconite, 205 
Alcohol, 168 
Alkalies, 95 
Alkaline waters, 102 
Alkaloid, definition of, 46 n. 
Aloes, 235 

Alterative medicines, 103 
Alum, 269 
Ammonia, 196, 256 
Anaesthetics, 215 
Antifebrin, 30 
Antipyrine, 30 
Apomorphine, 245 
Arsenic, 127 
Asafo3tida, 204 
Astringents, 265 

Barium, chloride of, 195 
Bathing waters, 103 
Belladonna, 179 
Benzoin, 28 
/J-Naphthol, 29 
Bismuth, 136 
Blancard's pills, 113 
Boracic acid, 35 
Bromide of potassium, 117 
Bromine, 32 
Buchu, 252 



Caffeine, 194 
Calomel, 282 
Calumba, 88 
Camboge, 240 
Camphor, 29, 203 
Cannabis Indica, 184 
Carbolic acid, 24 
Cascara sagrada, 237 
Castor oil, 233 
Cathartics, 225 
Chalybeate waters, 102 
Charcoal, 22 
Chinoline, 30 
Chloral, 220 
Chloric ether, 177 
Chloride of barium, 195 
Chlorine, 31 
Chloroform, 215 
Classification of Medicines, 1 
Clelland's solution, 96 
Clement's solution, 133 
Cocaine, 219 
Cod-liver oil, 52 

administration of, 61 
Colchicum, 136 
Cold, as an anaesthetic, 280 

as an antipyretic, 281 

as a styptic, 277 

as a tonic, 273 
Colocynth, 238 
Columbo, 88 

Compound cathartic pills, 241 
Conium, 213 
Copper, 136 

sulphate of, 248, 269 
Cream tartar, 243 
Creosote, 38 
Croton oil, 241 

Diaphoretics, 254 



292 



GENEEAL INDEX. 



Digitalis, 185, 250 

Disinfectants, introductory to use of, 
10 

classification of, 10 

general, 19 

special, 20 

uses in treatment of special dis- 
eases, 36 
Diuretics, 248 
Dover's powder, 167, 256 
Dry heat, 255, 285 

Elaterium, 240 

Eliminatives, 224 

Emetics, 244 

Epsom salts, 243 

Ergot, 198 

Ether, chloric, 177 

nitrous, spirit of, 177 
spiritus aetheris comp., 177 
sulphuric, 177 

Ethers, 176, 215 

Expectorants, 258 

Fowler's solution, 129, 133 
Functional medicines, 141 



Gallic acid, 270 
Gelsemium, 214 
Gentian, 88 

Glandular medicines, 224 
Glauber's salts, 243 



Laville's extract, 139 
Lead, 265 
Lime, 20 
Lime water, 22 
Linseed oil emulsion, 260 
Liquor ferri pernitratis, 268 
Liquor ferri subsulphatis, 268 
Lugol's solution, 112 

Magendie's solution, 167 
Magnesium, sulphate of, 243 
Medicinal remedies, introductory, 45 
Medicines, classification of, 1 
Mercury, 104, 250 
Mineral acids, 90 

waters, 97 
Moist heat, 255, 287 
Monsel's solution, 268 
Mydriatics, 178 

Naphthaline, 29 
Narcotics, 1.44 
Neurotics, 143 
Nitrate of silver, 133, 268 
Nitre, sweet spirit of, 256 
Nitric acid, 92 
Nitroglycerin, 192 
Nitro-muriatic acid, 93 
Nitrous ether, spirit of, 177 
Nitrous oxide, 219 
Non-medicinal remedies, 273 
Nux vomica, 191 



Heat, dry, 255, 285 
moist, 255, 287 
Hoffmann's anodyne, 177 
Hydrochloric acid, 91 
Hydrocyanic acid, 212 
Hyoscyamus, 183 
Hypnotics, 220 

Iodide of potassium, 113 
Iodine, 34, 111 
Iodoform, 35 
Ipecacuanha, 246 
Iron, 62 

administration of, 71 



Jaborandi, 257 
Jalap, 239 
Juniper, 253 

Labarraque's solution, 32 



Oil, castor, 233 

croton, 241 

of peppermint, 28 

of wintergreen, 28 
Opium, 144 
Oxide of zinc, 135 

Paraldehyd, 222 
Peppermint, oil of, 28 
Permanganate of potash, 36 
Phenacetin, 223 
Phosphate of sodium, 244 
Phosphoric acid, 94 
Phosphorus. 73 
Podophyllum, 239 
Poison, definition of, 12 
Potassium, iodide of, 113 
Prescriptions. See Clinical index, 
Prussic acid, 212 

Quassia, 88 
Quinine, 76 



GENERAL INDEX. 



^93 



Restorative medicines, 52 
Rhubarb, 235 
Rochelle salts, 244 

Salicin, 26 

Salicylate of soda, 26 
Salicylic acid, 26 
Saline cathartics, 242 

diuretics, 253 

waters, 99 
Salol, 27 
Salts 

Epsom, 243 

Glauber's, 243 

Rochelle, 244 
Scammony, 239 
Senna, 241 
Silver, 133 

nitrate of, 268 
Smith's solution, 33 
Soda, salicylate of, 26 

sulphite of, 34 
Sodium, phosphate of, 244 

sulphate of, 243 
Solution, Clement's, 133 

Fowler's, 129, 133 

Lugol's, 112 

Magendie's, 167 

Smith's, 33 
Spiritus aetheris comp., 177 
Squill, 251 
Stramonium, 183 
Strophanthus, 190 
Strychnine, 200 
Sulfonal, 223 



Sulphate of copper, 136, 248, 269 

of magnesium, 243 

of sodium, 243 

of zinc, 248 
Sulphite of soda, 34 
Sulphur, 34 
Sulphuric acid, 92 

ether, 177 
Sulphurous waters, 102 
Sweet spirit of nitre, 256 

Tannic acid, 269 

Tannin, 269 

Tartar emetic, 212 

Tartrate of potassium and sodium 

244 
Thymol, 30 
Turpentine, 251 

Valeriana, 204 
Vallet's mass, 69 
Vegetable bitters, 87 
Veratrum viride, 209 

"Warburg's tincture. 82 
Waters, alkaline, 102 

bathing, 103 

chalybeate, 102 

mineral, 97 

saline, 99 

sulphurous, 102 
Wintergreen, oil of, 28 
Wood smoke, 34 

Zinc, 135 

sulphate of, 248 



CLINICAL INDEX. 



Abscess in tonsils 

aconite, 208 
Accidental diseases, classification of, 

18 
Acne 

arsenic, 132 
ergot,- 199 
of bromism 

Fowler's solution, 123 
Adenitis 

cod-liver oil. 57 
Lugol's solution, 112 
Alcohol ism us 

oxide of zinc, 135 
veratrum viride, 175 
Amenorrhcea 
aloes, 236 
asafcetida, 204 
sulphate of iron, 70 
dry heat, 286 
Ansemia 

Blancard's pills, 113 
gentian, 88 

iron, 64. For prescription, 
see p. 71 
pernicious 

arsenic, 128 
Aneurism 

iodide of potassium, 116 
Aneurismal cough 

treatment of, 264 
Angina pectoris 
digitalis, 187 
nitrate of silver, 134 
nitrite of amyl, 194 
nitroglycerin, 193 
Anorexia 

vegetable bitters, 87 
Ascarides 

quassia, 88 
Asiatic cholera 
camphor, 203. 
See also p. 17 



Asthma 

arsenic, 131 
belladonna, 114, 180 
caffeine, 195 
Fowler's solution. 114 
Hoffmann's anodyne, 114, 178 
iodide of potassium, 114 
linseed oil emulsion, 260 
stramonium, 183. For prescrip- 
tions, see pp. 131, 260 
Atony, intestinal 

senna, 241 
of bladder 

juniper, 253 

Bed-sores 

tannate of lead, 267 
Biliousness. For prescription, see p. 

233 
Bladder, weakness of 

strychnine, 201 
Boils 

disinfection, 37 
Borborygmus 

bismuth, 136 
Bright's disease 

alcohol. 171 

cod-liver oil, 59 

ethers, 178 

iron, 64 

jaborandi, 257 

jalap, 239 

nitroglycerin, 193 

pilocarpine, 258 

quinine, 78. For prescription, 
see p. 188 
Bright's disease, chronic 

digitalis, 187 

mercury, 108, 250 

saline waters, 100 

tincture of iodine, 116 
Bronchitis 

ammonia, 196 



CLINICAL INDEX. 



295 



Bronchitis 

arsenic, 131 

balsams, 29 

buchu, 253 

hydriodic acid, 114 

iodide of potassium, 114 

sweet spirit of nitre, 177, 256 
acute 

linseed oil emulsion, 260 

tartar emetic, 212. For pre- 
scription, see p. 260 
capillary 

hot milk and lime water, 234 

ipecacuanha, 247 
catarrhal 

croton oil, 241 
chronic 

iron, 67 

nitric acid, 93 

saline waters, 101 

tinct. ferri muriatis, 261 

turpentine, 252 

zinc, 136 
congestive y 

croton oil, 241 

jalap, 239 
Broncho-pneumonia 

chloride of ammoDium, 197 
Bronchorrhcea 
nitric acid, 93 
zinc, 136 
Brow ague 

ergot, 200. See also under 
"Neuralgia.*' 
Burns 

lime water and olive oil, 97 
oil of peppermint, 28 

Calculi 

alkalies, 96 
Cancer 

permanganate of potash, 36 
of stomach 

sulphite of soda, 34 
Carbuncles 

disinfection, 37 
Cardiac dilatation 

digitalis, 186 
dropsy 

juniper, 253 

strophanthus, 191. For pre- 
scription, see pp. 108, 251 
exhaustion 

syrup of hypophosphite of 
sodium, 74 



Cardiac failure 

alcohol, 169 
irregularity 

belladonna, 180 
pain 

belladonna, 182 
Catarrh, mucous 

Lugol's solution, 112 
Cerebro-spinal meningitis 

application of cold, 280 
Chancroid 

iron, 69 
Chlorosis 

administration of, medicines in, 
48 
asafcetida, 204 
dry heat, 286 

iron, 64, 65. For prescrip- 
tions, see pp. 66, 236 
Cholera, asiatic 

camphor, 29, 203. See also 
p. 17 
infantum 

camphor, 29. For prescrip- 
tion, see p. 266 
morbus 

camphor, 159, 203 
Choleraic diarrhoea with vomiting 

For prescription, see p. 266 
Chorea 

arsenic, 131 
colchicum, 140 
oxide of zinc, 135 
Cirrhosis of liver 
mercury, 108 
Classification of accidental diseases, 

18 
Colic, biliary 

moist heat, 288 
intestinal 

chloric ether, 177 
renal, 

moist heat, 288 
Coma 

croton oil, 242 
alcoholic, 162 
apoplectic, 162 

from coucussion of brain, 163 
of opium poisoning, 161 
ursemic, 161 
Communicable diseases, 16 
specific, 17 
septic, 17 
Condylomata 

yellow wash, 111 



296 



CLINICAL INDEX. 



Congestion, hepatic 
ipecacuanha, 246 
muriate of ammonia, 198 
Conjunctivitis, chronic 

sulphate of copper, 269 
Constipation 
aloes, 235 
belladonna, 180 
calomel, 231 
camboge, 240 
castor oil, 233 
colocynth, 238 
croton oil, 242 
rhubarb, 236 
saline waters, 101 
strychnine, 202 

sulphate of iron, 71. For article 
on constipation, see p. 225. 
For prescriptions, see pp. 181, 
226 
Convulsions 

moist heat, 288 
of scarlet fever 

application of cold, 275 
puerperal 

application of cold, 275 
Coughs, for article on, see p. 258 
irritant 

chloral, 222 
hydrocyanic acid, 213 
uterine 

bromide of ammonium, 125 
Croup 

ipecacuanha, 247 
moist heat, 288 
sulphate of copper, 248 
false 

cold douche, 277 
ipecacuanha, 247 
Cystitis 

administration of medicines 

in, 49 
belladonna in, 181 
buchu, 252 
conium, 214 
disinfection, 36 
strychnine, 230 
chronic 

quinine, 83 

saline waters, 100. For pre- 
scription, see p. 252 
tannin, 270 



Delirium 



hyposulphite of sodium, 75 



Delirium 

oxide of zinc, 135 

veratrum viride, 211 
tremens, insomnia of, , 

sulfonal, 223 
Diabetes 

alkaline waters, 102 

Clement's solution, 133 

diaphoretics, 254 

iron, 68 
mellitus 

cod-liver oil 
Diarrhoea 

acetate of lead, 266 

camphor, 29 

chalk mixture, 97 

charcoal, 24 

Labarraque's solution, 32 

nitric acid, 93 

oil of wintergreen, 28 

opium, 157 

sulphuric acid, 92. For 
prescription, see p. 269; 
for description for diar- 
rhoea with gout, see p. 

:9 

choleraic 

ammonia, 197 
of phthisis 

liquor ferri pernitratis, 268 
summer 

aloes and rhubarb, 235. 
For prescription, see p. 
237 
Diphtheria 

bromine, 33 
iron, 69 
lime, 22 
moist heat, 288 
Dropsy 

administrations of medicines in, 

47 
elaterium, 240 
juniper, 253 

strophanthus, 191. For pre- 
scriptions, see pp. 108, 251 
Dysentery 

castor oil, 234 
charcoal, 24 
ergot, 200 
ipecacuanha, 247 
peppermint water, 156 
chronic 

aloes and rhubarb, 235 
bromide of potassium, 126 



CL1XICAL IXDEX. 



297 



Dysentery, chronic 

liquor ferri pernitratis, 268 
naphthaline, 29 
nitrate of silver, 134 
oil of peppermint, 28 
oil of wintergreen, 28 
sulphate of copper, 136 
For prescriptions, see pp. 
134, 269 
malignant 

Labarraque's solution, 32 
Dysmenorrhea 

administration of medicines in, 

49 
aloes, 236 
arsenic, 131 
asafcetida, 204 
bromides, 126 
juniper, 253 
turpentine, 252 
Dyspepsia 

belladonna, 180 
bismuth, 136 
charcoal, 24 

mineral acids, 91. For pre- 
scription, see p. 67 
Dysuria 

cannabis iodica, 185 

Eczema 

alkalies, 96 
arsenic, 132 
boracic acid, 35 
cod-liver oil, 60 
saline waters, 101. See also 
under Skin diseases, 
rheumatic 

mercury, 109 
Emphysema 
arsenic, 131 
hydriodic acid, 115 
iodide of potassium, 115. For 
prescription, see p. 260 
Endarteritis 

tincture of iodine, 116 
chronic 

mercury, 108 
saline waters, 100 
syphilitic 

iodide of potassium, 113 
Enteritis 

opium, 154 
Epididymitis 

mercury, 109 
Epilepsy, definition of, 120 



Epilepsy 

alcohol, 124 

bromide of potassium, 117, 122 

chloral, 124 

cod-liver oil. 59, 123 

conium, 213 

digitalis, 188 

ergot, 198 

Hoffmann's anodyne, 124 

iron, 66 

mercury, 108 

nitrate of silver, 134 

phosphorus, 74 

red iodide of mercury, 110 

sulphate of copper, 136 

syrup of hypophosphites, 123. 
For article on epilepsy, see p. 
118. 
Epistaxis 

cocaine, 220 
Erysipelas 

application of cold, 280 

lead and opium wash, 267 

lime, 22 
Expectorant coughs 

treatment of, 259 
Exudation, inflammatory 

red iodide of mercury, 110 



Favus 

mercury, 108 
Fevers 

aconite, 206 

application of cold, 282 
calomel, 232 
cream tartar, 244 
diaphoretics, 254, 255 
dry heat, 286 
ipecacuanha, 246 
iron, 66 

phenacetin, 224 
phosphoric acid, 94 
quinine, 84 
vegetable bitters, 89 
For antipyretic prescription, 
see p. 209 
intermittent, see Intermittent 

fever 
remittent, see Remittent fever 
Fibroid tumors 
ergot, 199 
Flatulency 

asafoetida, 204. For prescrip- 
tion, see p. 227 



298 



CLINICAL INDEX. 



Fractures 

application of cold, 280 

Gangrene 

bromine, 33 

Labarraque's solution, 32 
lime, 22 
opium, 148 
Gastralgia 

arsenic, 130 
Gastritis 

administration of medicines in,47 

arsenic, 129 
chronic 

calumba and bismuth, 89 
saline waters, 101 
Gastrodynia 

belladonna, 180 
bismuth, 136 
Globus hystericus 

belladonna, 180 
Goitre 

nitrate of silver, 135 
red iodide of mercury, 110 
strophanthus, 135 n 
Gonorrhoea 

cocaine, 220 
Gout 

colchicum, 137 
Laville's extract, 139 
quinine, 87, 139 
ripe fruit, 96. For prescrip- 
tion for gout with diar- 
rhoea, see p. 29 
chronic 

sulphurous waters, 102 
Gummata, syphilitic 

iodide of potassium, 113 

Hematuria 

cannabis indica, 185 
Haemoptysis 

ergot, 200 

ether spray, 278 

tannin, 270 . 
Haemorrhage 

ammonia, 196 

post-partum 
ergot, 199 
Haemorrhoids 

cocaine, 220 
Hay asthma 

arsenic, 131 

For prescription, see p. 131 
Hay fever 

cocaine, 220 



Headache 

ammonia, 196 
antifebrin, 30 
antipyrine, 30 
ergot, 200 
nitroglycerin, 194 
febrile 

application of cold, 280 
malarial 

arsenic, 129 
sick 

gelsemium, 214 
Heart disease 

iron, 67 
Hemicrania 

cold douche, 277 
ergot, 199 

valerianate of ammonium 
and chloride of ammo- 
mium, 205 
nocturnal syphilitic 
calomel, 105 
Hepatic congestion 

ipecacuanha, 246 
muriate of ammonia, 198 
dropsy 

juniper, 253 
Herpes 

mercury, 109 
Hyperidrosis 

belladonna, 182 
sulphuric acid, 92 
Hypochondriasis 

bromides, 125 
Hysteria 

asafoetida, 204 
/?-naphthol, 29 
benzoate of soda, 29 
bromides, 125 
phenacetin, 224 
rhubarb, 29 
valerian, 205 

Impotence 

cannabis indica, 185 
Incontinence of urine in children, 
nocturnal 
belladonna, 182 
Inflammation, exudative 

iodine, 115 
Insanity, insomnia of 

sulfonal, 223 
Insomnia 

alcohol, 170 
bromides, 126 



CLINICAL INDEX. 



299 



Insomnia 

chloral hydrate, 220 
paraldehyd, 222 
sulfonal, 223 
of delirium tremens 
oxide of zinc, 135 
Intermittent fever 

arsenic, 129 
Intestinal colic 

chloric ether, 177 
fermentation 
alkalies, 96 
henzoate of soda, 29 
/3-naphthol, 29 
bismuth, 136 
charcoal, 24 
lime water, 22 
rhubarb, 29 
salicylate of soda, 28 
salol", 28 
Iodism 

muriate tincture of iron, 112 
opium, 112 
quinine, 112 

Jaundice 

chloride of ammonia, 197 
ipecacuanha, 246 
iron, 64 
nitro-muriatic acid, 94 

Laryngitis 

moist heat, 288 

general treatment of, 268 
Lead poisoning 

iodide of potassium, 116 
Lepra 

alkalies, 96 

arsenic, 130 

liquor potassas, 130 
Leucorrhooa 

application of cold, 275 

permanganate of potash, 36 

saline waters, 100 
Lithsemia 

benzoate of soda, 139 

conium, 214 
Locomotor ataxia 

antifebrin. 30 

antipyrine, 30 

mercury, 108 

nitrate of silver, 133 

phenacetin, 224 
Lumbago 

cathartics, 233 



Lumbago 

salicylic acid, 27 

Malaria 

arsenic, 128 
castor oil, 234 
cold, 276 

compound cathartic pills, 238 
iron, 64 

podophyllum, 240 
quinine, 77, 264 
For prescription for the vaso- 
motor weakness of malaria, 
see pp. 276, 277 
Meningitis 

cold, 275 

red iodide of mercury, 110 
acute tubercular 

iodide of potassium, 116 
cerebro-spinal 

application of cold, 280 
croton oil, 242 
chronic 

ergot, 198 
mercury, 108 
phosphorus, 74 
subacute 

ergot, 198 
syphilitic 

iodide of potassium, 113 
Menorrhagia 

cannabis indica. 185 
Menses, suppression of 

application of dry heat, 286 
Mercurial poisoning 

iodide of potassium, 116 
Migraine 

cannabis indica, 184 
phenacetin. 224 
Muscular debility. For prescription, 
see p. 67 
tremors 

oxide of zinc, 135 
Myelitis 

nitrate of silver, 134 

Nasal catarrh, chronic 

cold douche, 277 
Nephritis, acute 

digitalis. 188, 250 
jaborandi, 257 
chronic interstitial 
mercury, 108 
scarlatinal 

jaborandi, 257 



300 



CLINICAL INDEX. 



Nervous debility 

alcohol, 170. For prescription, 
seep. 67 
Neuralgia 

aconite, 207 
ammonia, 197 
antifebrin, 84 
antipyrine, 84 
cannabis indica, 184 
cocaine, 220 
iron, 65 
'opium. 152 
phenacetin, 224 
phosphorus, 74 
quinine, 84 
valerian, 205 
For prescriptions, see pp. 197, 
208 
malarial 

arsenic, 129 
trigeminal 

ammonia and ethers, 178 
Neurasthenia 

mineral acids, 91 
phosphorus, 74 
Neuroses 

cod-liver oil, 59 
syphilitic 

iodide of potassium, 113 
Nodes, syphilitic 

iodide of potassium, 113 
Non-communicable diseases, 17 
Non-expectorant coughs 
treatment of, 261 

Offensive breath 

aloes and rhubarb, 235 

cascara sagrada, 137 
Opium poisoning, treatment of, 163 

For prescription, see p. 165 
Orchitis 

mercury, 109 
Otorrhcea 

boracic acid, 35 

bromine, 33 
Oxaluria 

nitro-muriatic acid, 94 
Ozsena 

permanganate of potash, 36 

Pachymeningitis 

conium, 213 

nitrate of silver, 134 

red iodide of mercury, 110 
Pain, inflammatory 

opium, 151 



Pain, camphor, 203 
Paralysis 

phosphorus. 74 
agitans 

nitrate of silver, 134 
Paraplegia 

strychnine, 201 
Pelvic irritation 

bromides, 125 
Pericarditis 

mercury, 109 
moist heat, 288 
Periostitis, rheumatic 
iodine, 115 
syphilitic 

conium, 113, 213 
iodide of potassium, 113 
tincture of opium, 113 
Peritonitis 

aconite, 207 
moist heat, 288 
opium, 148 
chronic 

mercury, 109 
Perityphlitis 

application of cold, 285 
Pertussis 

belladonna, 264 
Pharyngitis 

aconite, 20S 
Phthisis 

belladonna. 183 

bismuth. 136 

buchu, 253 

cod-liver oil, 60 

coffee, 261 

creosote, 39 

croton oil, 241 

disinfection, 15, 20, 38 

linseed oil emulsion, 260 

mercury, 109 

nitric acid, 93 

sulphite of soda, 34 

sulphuric acid, 92 

syrup of hypophosphite of 

sodium, 75 
zinc, 136 
cough of 

morphine, 262 
diarrhoea of 

liquor ferri pernitratis, 268 
night sweats of 

application of cold, 274 
Piles 

aloes, 236 



CLINICAL INDEX. 



301 



Piles 

saline waters, 99 

chronic 

application of cold, 275 
Pleurisy- 
aconite, 207 
moist heat, 288 

chronic 

mercury, 109 

cough of 

treatment of, 263 
Pneumonia 

aconite, 192, 207 

carbonate of ammonia, 196 

digitalis, 189 

ipecacuanha, 247 

iron, 69 

moist heat, 288 

nitroglycerin, 192 

saline diuretics, 253 

strophanthus, 191 
Portal congestion 

compound cathartic pills, 241. 
For prescription, see p. 81 
Post-part um haemorrhage 

application of heat, 287 

ergot, 199 
Pregnancy, vomiting of 

arsenic, 129 
Prescriptions 

anaemia, 71 

antipyretic, 209 

asthma, 260 

biliousness, 233 

Bright's disease, 188 

bronchitis, acute, 260 

cardiac dropsy, 108, 251 

chlorosis, 66, 236 

cholera infantum, 266 

choleraic diarrhoea with vomit- 
ing, 266 

constipation, 181, 226 

cystitis, chronic, 252 

diarrhoea with gout, 20 
chronic, 269 
summer, 237 

dropsy, 108, 251 

dysentery, chronic, 134, 269 

dyspepsia, 67 

emphysema, 260 

flatulency, 227 

gout with diarrhoea, 29 

hay asthma, 131 

malaria, vaso-motor weakness of 
276, 277 



Prescriptions 

muscular debility, 67 
nephritis, chronic interstitial, 

108 
nervous debility, 67 
neuralgia, 197, 208 
opium poisoning, 165 
portal congestion, 81 
rheumatism, 95 
chronic, 209 
scabies, 97 

summer diarrhoea, 237 
sunstroke, vaso-motor weakness 

of, 276 
typhoid fever, 39 
Prolapsus recti 

aloes, 236 

application of cold, 275 
strychnine, 201 
uteri 

application of cold, 275 
saline waters, 100 
Prostate gland, enlarged 
aloes, 236 
saline waters, 99 
Pruritus pudendae 

black wash, 110 
Psoriasis 

alkalies, 96 
arsenic, 130 
liquor potassae, 130 
mercury, 109 
Puerperal eclampsia 

veratrum viride, 210 
Pyaemia, definition of, 16 n 
Pyelitis, chronic 
tannin, 270 
turpentine, 252 

Quinsy 

aconite, 208 

Remittent fever 

administration of medicines in, 
47 
Rheumatic eczema 

mercury, 109 
Rheumatism 

alkalies, 95 
antifebrin, 30 
antipyrine, 30 
application of cold, 275 
mercury, 109 

phosphate of sodium, 244. 
For prescription, see p. 95 



302 



CLINICAL INDEX. 



Rheumatism 
acute 

veratrum viride, 211 
acute articular 

application of cold, 283 

moist heat, 288 

phenacetin, 224 

salicylic acid, 26 
chronic 

alkaline waters, 102 

cod-liver oil, 58 

sulphurous waters, 102 

warm water baths, 103. For 
prescription, see p. 209 
muscular 

cathartics, 233 

phenacetin, 224 

Scabies 

mercury, 108. For prescription 
see p. 97 
Scarlatinal nephritis 

digitalis. 188 

jaborandi, 257 
Scarlet fever 

application of cold, 285 

cream tartar, 244 

lime water and olive oil, 97 
Sciatica 

atropine, 184 

morphine, 184 
Scrofula 

Blancard's pills, 113 

cathartics, 233 

cod-liver oil, 56 

Lugol's solution. 112 
Secretions, glandular, arrest of 

belladonna, 182 
Septicaemia, definition of, 16 n 

quinine as a remedy in, 83 
Shock 

opium, 145 
Sick headache 

gelsemium, 214 
Skin diseases 

arsenic, 130 

black wash, 110 

cod-liver oil, 60 

disinfection, 37 

liquor potassre, 130 

mercury, 108 

phosphorus, 75 

saline waters, 100 
Sore throat 

aconite, 208 



Sore throat 

saline waters, 101 
Small-pox 

lime water and olive oil, 97 
Spasms 

opium, 153 
Spermatorrhoea 

bromides, 125 

ergot, 199 
Spinal cord, diseases of 

mercury, 108 
Spinal irritation 

croton oil, 241 
Spleen, enlarged 

ergot, 199 
Sprains 

belladonna, 184 

stramonium, 184 
Strangury 

cannabis indica, 185 
Stricture of urethra 

aconite, 49, 208 
Summer diarrhoea 

aloes and rhubarb, 235, 236 

nitric acid, 93. For prescrip- 
tion, see p. 237 
Sunstroke 

application of cold, 276, 283 

corrosive sublimate, 199 

ergot, 198 

red iodide of mercury, 110 
For prescription for the vaso- 
motor weakness of sunstroke, 
see p, 276 
Suppuration, prolonged 

quinine, 83 
Syncope, definition of, 161 

ammonia as a remedy in, 196 
Syphilis 

black wash, 110 

iodide of potassium, 113 

mercury, 104 

yellow wash, 111 
Syphilitic hemicrania, nocturnal 

calomel, 105 



Teething of children 

bromide of potassium, 126 
Tetanus 

bromide of potassium, 125 
Tic douloureux 

aconite, 207 

muriate of ammonia, 197 

phosphorus, 74 



CLINICAL INDEX. 



303 



Tinnitus aurium 

cold douche, 277 

nitroglycerin, 194 
Tonsillitis 

aconite, 208 

emetics, 244 

hydrochlorate of cocaine, 220 

ipecacuanha, 247 
Toothache 

camphor, 203 

oil of wintergreen, 28 
Toxicology 

alcoholic poisoning, 176, 211 

arsenical poisoning, 132 

digitalis poisoning, 186 

lead poisoning, 135. 267, 268 

mercurial poisoning. 106, 135 

opium poisoning, 160 

strychnine poisoning, 200 
Tubercular inflammation of lungs 
pure air, 20 

meningitis, acute 

iodide of potassium, 116 
Tuberculosis of lungs 

ipecacuanha, 246 
Tumors, fibroid 

ergot, 199 
Typhoid fever 

application of cold, 284 

bismuth, 136 

calomel, 232 

chlorine, 31 

disinfectants, 39 

hydrochloric acid, 92 

milk, 40 

turpentine, 252. For prescrip- 
tion, see p. 39 
Typhus fever 

lime, 22 



Ulcers 

iron, 69 

Lugol's solution, 112 

Urethra, irritable stricture of 

aconite, 208 

juniper, 253 

spasm of 

buchu, 253 
moist heat, 288 
Urine, incontinence of 
strychnine, 201 
nocturnal incontinence of, in 
children 
belladonna, 182 
Uterine cough 

treatment of. 264 
Uterus, chronic subinvolution of 

ergot. 199 

Uvula, relaxed 

alum, 269 

Vaginitis 

Lugol's solution, 112 
Vaso-motor association, laws of, 277 

weakness 

strychnine, 202 
"Vomiting of pregnancy 

arsenic, 129 

chloric ether, 177 

Water brash 

strychnine, 202 
Whooping cough 

bromide of ammonium, 125 

nitric acid, 93 
Wounds, disinfection of, 40 

Yellow fever, see p. 18 



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